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  • 151.
    Johansson, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Cesarini, Kristina G
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Contant, C F
    Persson, Lennart
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage.2001Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 32, nr 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage.

    METHODS: Two hundred eighty-one patients >/=65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998.

    RESULTS: The volume of elderly patients (>/=65 years of age) increased with time, especially patients >/=70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%; B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients.

    CONCLUSIONS: Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.

  • 152.
    Johnson, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Engquist, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Howells, Tim
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Nilsson, Pelle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Ronne-Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Lewén, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Rostami, Elham
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Bedside Xenon-CT Shows Lower CBF in SAH Patients with Impaired CBF Pressure Autoregulation as Defined by Pressure Reactivity Index (PRx)2016Ingår i: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 25, nr 1, s. 47-55Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Subarachnoid hemorrhage (SAH) is a disease with a high rate of unfavorable outcome, often related to delayed cerebral ischemia (DCI), i.e., ischemic injury that develops days-weeks after onset, with a multifactorial etiology. Disturbances in cerebral pressure autoregulation, the ability to maintain a steady cerebral blood flow (CBF), despite fluctuations in systemic blood pressure, have been suggested to play a role in the development of DCI. Pressure reactivity index (PRx) is a well-established measure of cerebral pressure autoregulation that has been used to study traumatic brain injury, but not extensively in SAH.

    OBJECTIVE: To study the relation between PRx and CBF in SAH patients, and to examine if PRx can be used to predict DCI.

    METHODS: Retrospective analysis of prospectively collected data. PRx was calculated as the correlation coefficient between mean arterial blood pressure (MABP) and intracranial pressure (ICP) in a 5 min moving window. CBF was measured using bedside Xenon-CT (Xe-CT). DCI was diagnosed clinically.

    RESULTS: 47 poor-grade mechanically ventilated patients were studied. Patients with disturbed pressure autoregulation (high PRx values) had lower CBF, as measured by bedside Xe-CT; both in the early (day 0-3) and late (day 4-14) acute phase of the disease. PRx did not differ significantly between patients who developed DCI or not.

    CONCLUSION: In mechanically ventilated and sedated SAH patients, high PRx (more disturbed CBF pressure autoregulation) is associated with low CBF, both day 0-3 and day 4-14 after onset. The role of PRx as a monitoring tool in SAH patients needs further studying.

  • 153. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Calculation of end-tidal carbon dioxide fractions in the Bain system1989Ingår i: Acta Anaesthesiologica Scandinavica, Vol. 33, s. 71-74Artikel i tidskrift (Refereegranskat)
  • 154. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Flow pattern and respiratory charac­teristics during halothane anaesthesia1985Ingår i: Acta Anaesthesiologica Scandinavica, Vol. 29, s. 309-314Artikel i tidskrift (Refereegranskat)
  • 155. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Fresh gas flow in coaxial Mapleson A and D circuits during spontaneous breating1986Ingår i: Acta Anaesthesiologica Scandinavica, Vol. 30, s. 588-593Artikel i tidskrift (Refereegranskat)
  • 156. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Influence of the respiratory flow pattern on rebreathing in Mapleson A and D circuits1987Ingår i: Acta Anaesthesiologica Scandinavica, Vol. 31, s. 174-178Artikel i tidskrift (Refereegranskat)
  • 157. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rebreathing, resistance and external work of breathing in three different coaxial Mapleson D systems1989Ingår i: Acta Anaesthesiologica Scandinavica, Vol. 33, s. 66-70Artikel i tidskrift (Refereegranskat)
  • 158. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Johansson, S L G
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rebreathing and ventilatory response to different fresh gas flows in the Bain and Lack systems: A clinical study1989Ingår i: Acta Anaesthesiologica Scandinavica, Vol. 33, s. 71-74Artikel i tidskrift (Refereegranskat)
  • 159.
    Jonsson, Niklas
    et al.
    Karolinska Inst, Dept Physiol & Pharmacol, S-17177 Stockholm, Sweden.
    Gille-Johnson, Patrik
    Karolinska Inst, Dept Med, S-17177 Stockholm, Sweden.
    Martling, Claes-Roland
    Karolinska Inst, Dept Physiol & Pharmacol, S-17177 Stockholm, Sweden.
    Xu, Shengyuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Venge, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Mårtensson, Johan
    Karolinska Inst, Dept Physiol & Pharmacol, S-17177 Stockholm, Sweden.
    Performance of plasma measurement of neutrophil gelatinase-associated lipocalin as a biomarker of bacterial infections in the intensive care unit2019Ingår i: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 53, s. 264-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To assess the value of dimeric neutrophil-gelatinase associated lipocalin (NGAL) as an early marker of bacterial infection and its response to antibiotic therapy in intensive care unit (ICU) patients.

    Materials & methods: We measured daily plasma dNGAL in 198 patients admitted to a mixed ICU. Likelihood of infection was determined with International Sepsis Forum criteria. Wemeasured dNGAL in 145 healthy controls to establish normal values.

    Results: ICU patients had higher dNGAL than healthy controls. A suspected or confirmed infection was independently associated with 90% (95% CI 15-215%) higher dNGAL than absence of infection. We observed no association between acute kidney injury and dNGAL. Diagnostic accuracy at antibiotic treatment initiation, assessed with area under the receiver-operating characteristics curve (AUC-ROC), for dNGAL was 0.70 (95% CI 0.60-0.79). AUC-ROC for dNGAL 24 h before antibiotic treatment initiation was 0.54 (95% CI 0.41-0.66). The mean (95% CI) change of dNGAL in the first 2 days after appropriate antibiotic therapy initiation was -31 (-49,-13)%.

    Conclusions: In our cohort of ICU patients, plasma dNGAL was associated with presence of bacterial infections independent of AKI but it performed poor as a predictor of infections. Following antibiotic therapy, dNGAL markedly decreased-supporting further exploration of dNGAL-guided antibiotic de-escalation.

  • 160.
    Jonsson, Niklas
    et al.
    Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Nilsen, Tom
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Gille-Johnson, Patrik
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden..
    Bell, Max
    Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden..
    Martling, Claes-Roland
    Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden..
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Mårtensson, Johan
    Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden..
    Calprotectin as an early biomarker of bacterial infections in critically ill patients: an exploratory cohort assessment2017Ingår i: Criminology & Public Policy, ISSN 1441-2772, E-ISSN 1941-1006, Vol. 19, nr 3, s. 205-213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Calprotectin is the most abundant protein in the cytosolic fraction of neutrophils, and neutrophil degranulation is a major response to bacterial infections.

    OBJECTIVES: To assess the value of plasma calprotectin as an early marker of bacterial infections in critically ill patients and compare it with the corresponding values for procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC).

    METHODS: We measured daily plasma calprotectin levels in 110 intensive care unit patients using a newly developed turbidimetric assay run on clinical chemistry analysers. The likelihood of infection was determined according to the International Sepsis Forum criteria.

    RESULTS: Overall, 58 patients (52.7%) developed a suspected or confirmed bacterial infection. Plasma calprotectin predicted such infections within 24 hours with an area under the receiver operating characteristics curve (ROC area) of 0.78 (95% CI, 0.68-0.89). The ROC area for calprotectin was significantly greater than the corresponding ROC areas for WBC (P < 0.001) and PCT (P = 0.02) but only marginally better than the ROC area for CRP (0.71; 95% CI, 0.68-0.89).

    CONCLUSION: Plasma calprotectin appears to be a useful early marker of bacterial infections in critically ill patients, with better predictive characteristics than WBC and PCT.

  • 161.
    Jung, Christian
    et al.
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany;Heinrich Heine Univ, Div Cardiol & Intens Care, Univ Hosp Dusseldorf, Dusseldorf, Germany;Univ Hosp Dusseldorf, Heinrich Heine Univ Dusseldorf, Med Fac, Div Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany.
    Wernly, Bernhard
    Paracelsus Med Univ, Dept Cardiol, Salzburg, Austria.
    Muessig, Johanna M.
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany.
    Kelm, Malte
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany.
    Boumendil, Ariane
    Hop St Antoine, AP HP, Serv Reanimat Med, F-75012 Paris, France.
    Morandi, Alessandro
    Hosp Ancelle Cremona, Dept Rehabil, Geriatr Res Grp, Brescia, Italy.
    Andersen, Finn H.
    Alesund Hosp, Dep Anaesthesia & Intens Care, Alesund, Norway;NTNU, Dep Circulat & Med Imaging, Trondheim, Norway;Alesund Hosp, ICU, Alesund, Norway.
    Artigas, Antonio
    Autonomous Univ Barcelona, Dept Intens Care Med, CIBER Enjermedades Respiratorias, Corp Sanitaria Univ Parc Tauli, Sabadell, Spain;Univ Hosp Sagrad Corazon, Dept Intens Care Med, Barcelona, Spain;Univ Hosp Gen Catalunya, Barcelona, Spain.
    Bertolini, Guido
    IRCCS, Ist Ric Farmacol Mario Negri, Lab Epidemiol Clin, Ctr Coordinamento GiViTI,Dipartimento Salute Pubb, I-24020 Bergamo, Italy.
    Cecconi, Maurizio
    Humanitas Univ, Dept Anaesthesia, IRCCS, Inst Clin Humanitas, Milan, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Dept Anaesthesia & Intens Care Med, Aarhus, Denmark;Aarhus Univ Hosp, Skejby, Denmark.
    Faraldi, Loredana
    Grande Osped Metropolitano Niguarda, Milan, Italy.
    Fjolner, Jesper
    Aarhus Univ Hosp, Dept Anaesthesia & Intens Care Med, Aarhus, Denmark;Randers Reg Hosp, ITA, Randers, Denmark.
    Lichtenauer, Michael
    Paracelsus Med Univ, Dept Cardiol, Salzburg, Austria.
    Bruno, Raphael Romano
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Dublin, Ireland;Mater Misericordiae Univ Hosp, Dept Crit Care Med, Dublin, Ireland.
    Moreno, Rui
    Hosp Sao Jose, Ctr Hosp Lisboa Cent, Unidade Cuidados Intensivos Neurocrit, Fac Ciencia Med Lisboa,Nova Med Sch, Lisbon, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Dept Intens Care, 1K12IC, Ghent, Belgium;Ghent Univ Hosp, Dept Intensive Care, Ghent, Belgium.
    Ohman, Christina Agvald
    Karolinska Univ Hosp, Solna, Sweden.
    Pinto, Bernadro Bollen
    Geneva Univ Hosp, Geneva, Netherlands;Geneva Univ Hosp, Peri Intervent Intermidate Care SINPI, Geneva, Switzerland.
    Soliman, Ivo W.
    Univ Utrecht, Dept Intens Care Med, Univ Med Ctr, Utrecht, Netherlands.
    Szczeklik, Wojciech
    Jagiellonian Univ, Intens Care & Perioperat Med Div, Med Coll, Krakow, Poland;Univ Hosp Krakow, Dept Intens Care & Perioperat Med, Krakow, Poland.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Schwarzach, Austria.
    Watson, Ximena
    St Georges Univ Hosp, London, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa Tsakalof Larissa, Intens Care Unit, Larisa, Greece.
    De Lange, Dylan W.
    Univ Utrecht, Dept Intens Care Med, Univ Med Ctr, Utrecht, Netherlands.
    Guidet, Bertrand
    Hop St Antoine, Hop Paris, Serv Reanimat Med, F-75012 Paris, France;UPMC Univ Paris 06, Sorbonne Univ, UMR S 1136, Inst Pierre Louis Epidemiol & Sante Publ, F-75013 Paris, France;INSERM, UMR S 1136, Inst Pierre Louis Epidemiol & Sante Publ, F-75013 Paris, France;Reanimat Med, St Antoine, France.
    Flaatten, Hans
    Univ Bergen, Dept Clin Med, Dept Anaestesia & Intens Care, Haukeland Univ Hosp, Bergen, Norway;Haukeland Hosp, Gen ICU, Bergen, Norway.
    Schmutz, Rene
    Hosp St John God Vienna, B5, Vienna, Austria.
    Wimmer, Franz
    Kardinal Schwarzenbergsches Krankenhaus, Schwarzach Im Pongau, Austria.
    Eller, Philipp
    Med Univ Graz, Intensivstn Univ, Klin Innere Med, Graz, Austria.
    Joannidis, Michael
    Univ Hosp Innsbruck, MICU, Innsbruck, Austria.
    De Buysscher, Pieter
    AZ Sint Lucas Ghent, Dept Intens Care, Ghent, Belgium.
    De Neve, Nikolaas
    OL Vrouwhosp Aalst, Aalst, Belgium.
    Swinnen, Walter
    AZ Sint Blasius Dendermonde, Dept Intens Care Med, Dendermonde, Belgium.
    Abraham, Paul
    Geneva Univ Hosp, Adult Intens Care SIA, Geneva, Switzerland.
    Hergafi, Leila
    Hop Fribourgeois, Serv Soins Intensifs, Fribourg, Switzerland.
    Schefold, Joerg C.
    Univ Bern, Univ Klin Intensivmed, Inselspital, Bern Univ Hosp, Bern, Switzerland.
    Biskup, Ewelina
    Univ Hosp Basel, Med ICU, Basel, Switzerland.
    Piza, Petr
    IKEM, KARIP, Prague, Czech Republic.
    Taliadoros, Ioannis
    Nicosia Gen Hosp, CY001, Aglandjia, Cyprus.
    Dey, Nilanjan
    Reg Hosp Herning, Intens Herning, Herning, Denmark.
    Solling, Christoffer
    Reg Hosp Viborg, Viborg, Denmark.
    Rasmussen, Bodil Steen
    Aalborg Univ Hosp, ICU, Aalborg, Denmark.
    Forceville, Xavier
    Ctr Hosp Meaux, Reanimat Med Chirurg, Meaux, France.
    Besch, Guillaume
    CHRU Besancon, Dept Anesthesie Reanimat Chirurg, Besancon, France.
    Mentec, Herve
    Ctr Hosp Victor Dupouy Argenteuil, Serv Reanimat Polyvalente, Argenteuil, France.
    Michel, Philippe
    CH Camelle Portes Oise, Beaumont Sur Oise, France;CH Rene Dubos, Reanimat Med Chirurg, Pontoise, France.
    Mateu, Philippe
    CH Charleville Mezieres, Reanimat Polyvalente, Charleville Mezieres, France.
    Vettoretti, Lucie
    CHRU Besancon, Reanimat Med, Besancon, France.
    Bourenne, Jeremy
    CHU Marseille Timone, Reanimat Urgences & Med, Marseille, France.
    Marin, Nathalie
    Hop Cochin, Reanimat Med, Paris, France.
    Guillot, Max
    Hop Hautepierre, Reanimat Med, Strasbourg, France.
    Aissaoui, Naida
    Hop Europeen Georges Pompidou, Reanimat Med, Paris, France.
    Goulenok, Cyril
    Hop Prive Jacques CARTIER, Reanimat Med, Massy, France.
    Thieulot-Rolin, Nathalie
    Hosp Marc Jacquet, Intens Care Med Dept, F-77000 Melun, France.
    Messika, Jonathan
    Louis Mourier, Reanimat Med Chirurg, Colombes, France.
    Lamhaut, Lionel
    Necker AP HP, Polyvalente Adult ICU, Paris, France.
    Charron, Cyril
    Univ Hosp Ambroise Pare, Med Surg ICU, Paris, France.
    Lauten, Alexander
    Charite Univ Med Berlin, Dept Cardiol, Berlin, Germany;Charite Univ Med Berlin, DZHK Berlin Partner Side, Berlin, Germany.
    Sacher, Anna Lena
    Charite Univ Med Berlin, Dept Anesthesiol, Berlin, Germany.
    Brenner, Thorsten
    Heidelberg Univ Hosp, Dept Anesthesiol, Heidelberg, Germany.
    Franz, Marcus
    Friedrich Schiller Univ, Jena Univ Hosp, Dept Internal Med, Jena, Germany.
    Bloos, Frank
    Friedrich Schiller Univ, Jena Univ Hosp, Dept Anesthesiol, Jena, Germany.
    Ebelt, Henning
    Catholic Hosp St Johann Nepomuk, Dept Med 2, Erfurt, Germany.
    Schaller, Stefan J.
    Tech Univ Munich, Klinikum Rechts Isar, Dept Anesthesiol, Munich, Germany.
    Fuest, Kristina
    Tech Univ Munich, Klinikum Rechts Isar, Dept Anesthesiol, Munich, Germany.
    Rabe, Christian
    Tech Univ Munich, Klinikum Rechts Isar, Dept Clin Toxicol, Munich, Germany.
    Dieck, Thorben
    Hosp Hannover, Med Sch, Dept Anaesthesiol & Intens Care, Hannover, Germany.
    Steiner, Stephan
    St Vincenz Krankenhaus Limburg, Dept Cardiol Pneumol & Intens Care, Limburg, Germany.
    Graf, Tobias
    Univ Heart Ctr Luebeck, Dept Cardiol, Lubeck, Germany.
    Nia, Amir M.
    Heinrich Heine Univ, Div Cardiol & Intens Care, Univ Hosp Dusseldorf, Dusseldorf, Germany.
    Janosi, Rolf Alexander
    Univ Hosp Essen, Dept Cardiol & Vasc Dis, Essen, Germany.
    Meybohm, Patrick
    Frankfurt Univ Hosp, Dept Anaesthesiol Intens Care Med & Pain Therapy, Frankfurt, Germany.
    Simon, Philipp
    Univ Hosp Leipzig, Dept Anaesthesiol & ICM, Leipzig, Germany.
    Utzolino, Stefan
    Univ Klinikum Freiburg, Dept Gen & Visceral Surg, Freiburg, Germany.
    Rahmel, Tim
    Univ Hosp Knappschaftskrankenhaus Bochum, Dept Anaesthesiol Intens Care Med, Bochum, Germany.
    Barth, Eberhard
    Univ Ulm, Dept Anaesthesiol, Ulm, Germany.
    Schuster, Michael
    Univ Hosp Mainz, Dept Anaesthesiol, Mainz, Germany.
    Aidoni, Zoi
    UGHT AHEPA, ICU, Athens, Greece.
    Aloizos, Stavros
    Army Share Fund Hosp, ICU, Athens, Greece.
    Tasioudis, Polychronis
    G Gennimatas Hosp Thessaloniki, ICU, Thessaloniki, Greece.
    Lampiri, Kleri
    Gen Hosp Kavala, ICU, Kavala, Greece.
    Zisopoulou, Vasiliki
    Gen Hosp Larissa, ICU1, Larisa, Greece.
    Ravani, Ifigenia
    Gen Hosp & Atras, ICU, Achaea, Greece.
    Pagaki, Eumorfia
    Gen Hosp Trikala Greece, ICU, Trikala, Greece.
    Antoniou, Angela
    Volos Gen Hosp, ICU, Volos, Greece.
    Katsoulas, Theodoros A.
    Ag Anargyroi Gen Hosp, ICU, Kifisia, Greece.
    Kounougeri, Aikaterini
    Konstantopoule Gen Hosp, ICU, Athens, Greece.
    Marinakis, George
    Korgialenio Benakio G Hosp Athens, ICU, Athens, Greece.
    Tsimpoukas, Fotios
    Lamia Gen Hosp, ICU, Lamia, Greece.
    Spyropoulou, Anastasia
    Panarkadian Gen Hosp Tripolis, ICU, Tripoli, Greece.
    Zygoulis, Paris
    Univ Hosp Larisa, Gen ICU, Thessaly, Greece.
    Kyparissi, Aikaterini
    HIPPOCRATEIO Gen Hosp Athens, ICU, Athens, Greece.
    Gupta, Manish
    Max Super Special Hosp, MICU, Vaishali, India.
    Gurjar, Mohan
    Sanjay Gandhi Postgrad Inst Med Sci, Dept Crit Care Med, Lucknow, Uttar Pradesh, India.
    Maji, Ismail M.
    St Johns Med Coll Hosp, MICU, Bangaluri, India.
    Hayes, Ivan
    Cork Univ Hosp, CUH GICU, Cork, Ireland.
    Kelly, Yvelynne
    St James Hosp, Gen ICU, Dublin, Ireland.
    Westbrook, Andrew
    St Vincents Univ Hosp, ICU, Dublin, Ireland.
    Fitzpatrick, Gerry
    Tallaght Hosp, Tallaght Intens Care, Dublin, Ireland.
    Maheshwari, Darshana
    Univ Hosp Galway, UHG ICU, Galway, Ireland.
    Motherway, Catherine
    Univ Hosp Limerick, ICU, Limerick, Ireland.
    Negri, Giovanni
    Osped G Fornaroli, ASST Ovest Milanese Presidio Magenta, Magenta, Italy.
    Spadaro, Savino
    Azienda Osped Univ St Anna, Units Terapia Intens Serv Anestesia, Ferrara, Italy.
    Nattino, Giuseppe
    ASST Lecco Osped A Manzoni, Rianimaz Gen, Lecce, Italy.
    Pedeferri, Matteo
    Presidio Osped S Leopoldo Mand, Rianimaz, AO Prov Lecco, Merate, Italy.
    Boscolo, Annalisa
    Azienda Osped Padova, Giustiniani I & II Istar, Padua, Italy.
    Rossi, Simona
    Azienda Osped G Salvini, Presidio Osped Rho, Serv Anestesia Rianimaz, Rhod, Italy.
    Calicchio, Giuseppe
    Azienda Osped Univ San Giovanni Dio & Ruggi Arago, Ctr Rianimaz, Salerno, Italy.
    Cubattoli, Lucia
    Azienda Osped Univ Senese, Rianimaz Gen, Siena, Italy.
    Di Lascio, Gabriella
    Azienda Osped Univ Careggi, Terapia Intens Emergenza, Florence, Italy.
    Barbagallo, Maria
    Azienda Osped Univ Parma, UO Anestesia Rianimaz Terapia Intens 2, Parma, Italy.
    Berruto, Francesco
    Osped E Agnelli, Rianimaz, Pinerolo, Italy.
    Codazzi, Daniela
    Fdn IRCCS Ist Nazl Tumori, Unita Terapia Intens, Milan, Italy.
    Bottazzi, Andrea
    Fdn IRCCS Policlin S Matteo, Rianimaz 2, Pavia, Italy.
    Fumagalli, Paolo
    Fdn Policlin San Matteo, Rianimaz 1, Pavia, Italy.
    Negro, Giancarlo
    Osped Francesco Ferrari, Anestesia & Rianimaz 1, Casarano, Italy.
    Lupi, Giuseppe
    Osped Maggiore, Serv Anestesia & Rianimaz, Cremona, Italy.
    Savelli, Flavia
    Osped Maurizio Bufalini, Anestesia & Rianimaz TI 2, Cesena, Italy.
    Vulcano, Giuseppe A.
    Osped Civile Nicola Giannettasio, Terapia Intens, Rossano, Italy.
    Fumagalli, Roberto
    Osped Niguarda Ca Granda, Anestesia & Rianimaz 1, Milan, Italy.
    Marudi, Andrea
    Nuovo Osped Civile St Agostino Estense, Rianimaz Neurorianimaz, Modena, Italy.
    Lefons, Ugo
    Osped Alta Val dElsa, Terapia Intens, Poggibonsi, Italy.
    Lembo, Rita
    Osped Castelli Verbania, Rianimaz Gen, Verbania, Italy.
    Babini, Maria
    Osped Civile Lugo, Serv Anestesia & Rianimaz, Lugo, Italy.
    Paggioro, Alessandra
    Osped Infermi Biella, ASL BI, Struttura Semplice Rianimaz & Terapia Intens, Biella, Italy.
    Parrini, Vieri
    Osped Mugello, Anestesia & Rianimaz, Borgo San Lorenzo, Italy.
    Zaccaria, Maria
    Osped Cirie, Rianimaz & Terapia Intens, Turin, Italy.
    Clementi, Stefano
    Osped Sesto San Giovanni, Terapia Intens Polivalente, Sesto San Giovanni, Italy.
    Gigliuto, Carmelo
    Azienda Osped Prov Pavia, Osped Vigevano, Rianimaz, Vigevano, Italy.
    Facondini, Francesca
    Osped Infermi, Reparto Rianimaz & Terapia Intens, Rimini, Italy.
    Pastorini, Simonetta
    Osped P Cosma AUSL 15 Alta Padovana, Serv Anestesia Rianimaz, Camposampiero, Italy.
    Munaron, Susanna
    Osped San Giacomo Augusta, Unita Terapia Intens, Castelfranco Veneto, Italy.
    Calamai, Italo
    Osped San Giuseppe, Rianimaz, Empoli, Italy.
    Bocchi, Anna
    Osped San Luca, Terapia Intens, Trecenta, Italy.
    Adorni, Adele
    Osped Valduce, Unita Terapia Intens Rianimatoria, Como, Italy.
    Bocci, Maria Grazia
    Policlin Agostino Gemelli, Ctr Rianimaz, Rome, Italy.
    Cortegiani, Andrea
    Univ Palermo, Unita Terapia Intens Polivalente, Policlin P Giaccone, Palermo, Italy.
    Casalicchio, Tiziana
    Osped San Giovanni Bosco, Terapia Intens, Turin, Italy.
    Mellea, Serena
    Osped Santa Maria Misericordia, Unita Terapia Intens, Perugia, Italy.
    Graziani, Elia
    Santa Maria Croci, Unita Operat Anestesia & Rianimaz, Ravenna, Italy.
    Barattini, Massimo
    Osped Santa Maria Nuova, Rianimaz, Florence, Italy.
    Brizio, Elisabetta
    Osped SS Annunziata, Serv Rianimaz, Taranto, Italy.
    Rossi, Maurizio
    Azienda Osped St Anna Como Presidio Menaggio, UO Anestesia & Rianimaz, Menaggio, Italy.
    Hahn, Michael
    Haugesund Hosp, ICU, Haugesund, Norway.
    Kemmerer, Nicolai
    Kongsberg Hosp, ICU, Kongsberg, Norway.
    Strietzel, Hans Frank
    Kristiansund Hosp, ICU, Kristiansand, Norway.
    Dybwik, Knut
    Nordlandssykehuset Bodo, ICU, Bodo, Norway.
    Legernaes, Terje
    Hamar Hosp, ICU, Hamar, Norway.
    Klepstad, Pal
    St Olavs Univ Hosp, Dept Intens Care Med, Trondheim, Norway.
    Olaussen, Even Braut
    Stavanger Univ Hosp, ICU, Stavanger, Norway.
    Olsen, Knut Inge
    Namsos Hosp, ICU, Namsos, Norway.
    Brresen, Ole Marius
    Telemark Hosp, ICU, Skien, Norway.
    Bjorsvik, Geir
    Univ Hosp Tromso, ICU, Tromso, Norway.
    Maini, Sameer
    Alesund Hosp, Med ICU, Alesund, Norway.
    Fehrle, Lutz
    Molde Hosp, ICU, Molde, Norway.
    Czuczwar, Miroslaw
    First Publ Teaching Hosp Lublin, ICU, Lublin, Poland.
    Krawczyk, Pawel
    Univ Hosp Krakow, ICU, Krakow, Poland.
    Zietkiewicz, Miroslaw
    John Paul II Hosp Krakow, Resp & Thorac Surg ICU, Krakow, Poland.
    Nowak, Lukasz R.
    Oncol Krakow Branch, Dept Anaesthesiol & Intens Care, Maria Sklodowska Curie Memo Rial Inst, Krakow, Poland.
    Kotfis, Katarzyna
    Pomeranian Med Univ, Dept Anaesthesia Intens Care & Acute Poisonin, Teaching Hosp 2, Szczecin, Poland.
    Cwyl, Katarzyna
    RCZ Lublin, ICU, Lublin, Poland.
    Gajdosz, Ryszard
    Scanmed St Raphael Hosp Krakow, Dept Anaesthesiol & Intens Care, Krakow, Poland.
    Biernawska, Jowita
    Pomeranian Med Univ, Dept Anaesthesiol & Intens Care, Teaching Hosp 1, Szczecin, Poland.
    Bohatyrewicz, Romuald
    Pomeranian Med Univ, Dept Anaesthesiol & Intens Care, Teaching Hosp 1, Szczecin, Poland.
    Gawda, Ryszard
    Univ Hosp Opole, Dept Anaesthesiol & Intens Care, Opole, Poland.
    Grudzien, Pawel
    Edward Szczekl Specialist Hosp Tarnow, ICU, Tarnow, Poland.
    Nasilowski, Pawel
    Gabriel Narutowicz Specialist Hosp Krakow, Dept Anaesthesiol & Intensive Care, Krakow, Poland.
    Popek, Natalia
    Stefan Zeromski Specialist Hosp Krakow, Dept Anaesthesiol & Intens Care, Krakow, Poland.
    Cyrankiewicz, Waldemar
    Antoni Jurasz Univ Hosp 1 Bydgoszcz, Dept Anaesthesiol & Intens Care, Bydgoszcz, Poland.
    Wawrzyniak, Katarzyna
    Antoni Jurasz Univ Hosp 1 Bydgoszcz, Dept Anaesthesiol & Intens Care, Bydgoszcz, Poland.
    Wnuk, Marek
    John Paul II Mem Hosp Belchatow, Dept Anaesthesiol & Intens Care, Belchatow, Poland.
    Maciejewski, Dariusz
    Prov Hosp Bielsko Biala, Dept Anaesthesiol & Intens Care, Bielsko Biala, Poland.
    Studzinska, Dorota
    St John Grande Hosp, Dept Anaesthesiol Ogy & Intens Care, Krakow, Poland.
    Zukowski, Maciej
    Pomeranian Med Univ, Dept Anaesthesiol Intens Care & Acute Poisoning, Teaching Hosp 2 Szczecin, Szczecin, Poland.
    Bernas, Szymon
    Dr Wladyslaw Bieganski Reg Specialist Hosp Lodz, Dept Anaesthesiol & Intens Therapy, Ctr Artificial Extracorporeal Kidney & Liver Supp, Lodz, Poland.
    Piechota, Mariusz
    Dr Wladyslaw Bieganski Reg Specialist Hosp Lodz, Dept Anaesthesiol & Intens Therapy, Ctr Artificial Extracorporeal Kidney & Liver Supp, Lodz, Poland;Ctr Artificial Extracorporeal Kidney & Liver Supp, Szczecin, Poland.
    Nowak, Ilona
    Univ Hosp Krakow, Dept Intens Care & Perioperat Med, Krakow, Poland.
    Fronczek, Jakub
    Univ Hosp Krakow, Dept Intens Care & Perioperat Med, Krakow, Poland.
    Serwa, Marta
    Med Univ Lodz, Univ Hosp, Lodz, Poland;Med Univ Lodz, Educ Ctr, Lodz, Poland.
    Machala, Waldemar
    Med Univ Lodz, Educ Ctr, Lodz, Poland;Med Univ Lodz, Dept Anaesthesiol & Intensive Care, Univ Hosp, Lodz, Poland.
    Stefaniak, Jan
    Univ Clin Ctr Gdansk, Dept Anaesthesiol & Intens Care, Gdansk, Poland.
    Wujtewicz, Maria
    Univ Clin Ctr Gdansk, Dept Anaesthesiol & Intens Care, Gdansk, Poland.
    Maciejewski, Pawel
    Orthoped Rehabil Univ Hosp Zakopane, Dept Anaesthesiol & Intens Care, Zakopane, Poland.
    Szymkowiak, Malgorzata
    Jozef Strus Hosp Poznan, Dept Anaesthesiol & Intens Care, Poznan, Poland.
    Adamik, Barbara
    Wroclaw Univ Hosp, Dept Anaesthesiol & Intens Care, Wroclaw, Poland.
    Catorze, Nuno
    CH Medio TEJO, UCIP, Tomar, Portugal.
    Branco, Miguel Castelo
    EPE, Ctr Hosp Cova Beira, Unidade Cuidados Intensivos, Covilha, Portugal.
    Barros, Ines
    Ctr Hosp Tondela Viseu, Unidade Cuidados Intensivos Polivalente, Viseu, Portugal.
    Barros, Nelson
    Ctr Hosp Tras os Montes & Alto Douro, Serv Med Intens, Vila Real, Portugal.
    Krystopchuk, Andriy
    Hosp Faro, Ctr Hosp Algarve, Intens Care & Emergency Dept, Faro, Portugal.
    Honrado, Teresa
    Hosp Sao Joao, Unidade Cuidados INtensivos Polivalente, Porto, Portugal.
    Sousa, Cristina
    Hosp Luz, UCI, Lisbon, Portugal.
    Munoz, Francisco
    Hosp SAMS, UMI, Lisbon, Portugal.
    Rebelo, Marta
    Hosp Egas Moniz, UCIP, Lisbon, Portugal.
    Gomes, Rui
    Hosp Garcia Orta, UCI, Almada, Portugal.
    Nunes, Jorge
    Hosp Lusiadas Lisboa, Unidade Cuidados Intensivos, Lisbon, Portugal.
    Dias, Celeste
    Hosp Lusiadas Lisboa, Unidade Cuidados Intensivos, Lisbon, Portugal.
    Fernandes, Ana Margarida
    Hosp S Jose CHLC EPE, UCI Neurocrit, Lisbon, Portugal.
    Petrisor, Cristina
    Clin Emergency Cty Hosp Cluj, Anaesthesia & Intensive Care 1, Cluj Napoca, Portugal.
    Constantin, Bodolea
    Municipal Hosp, ATI, Viana Do castelo, Portugal.
    Belskiy, Vladislav
    Privolzhskiy Dist Med Ctr, Dept Anesthesiol & Intens Care, Moscow, Russia.
    Boskholov, Boris
    Zhadkevich Clin Hosp, Dept Intens Care, Moscow, Russia.
    Rodriguez, Enver
    Gen Univ Castellon, UCI, Castellon De La Plana, Spain.
    Rebollo, Sergio
    HGU Santa Lucia, ICU, Murcia, Spain.
    Aguilar, Gerardo
    Hosp Clin Univ Valencia, Unidad Reanimac, Surg ICU, Valencia, Spain.
    Masdeu, Gaspar
    Hosp Tortosa Verge Cinta, Servei Med Intens, Tortosa, Spain.
    Irazabal Jaimes, Marian
    Hosp Gen Cataluna, Crit Care Unit, Barcelona, Spain.
    Prado Mira, Angela
    Hosp Gen Univ Albacete, Med Intens, Albacete, Spain.
    Bodi, Maria A.
    Hosp Univ Tarragona Joan XXIII, Gen ICU, Tarragona, Spain.
    Barea Mendoza, Jesus A.
    Hosp Univ 12 Octubre, Serv Med Intens, Madrid, Spain.
    Lopez-Cuenca, Sonia
    Hosp Univ Getafe, Serv Med Intens & Grandes Quemados, Getafe, Spain.
    Homez Guzman, Marcela
    Hosp Univ Henares, ICU, Coslada, Spain.
    Rico-Feijoo, Jesus
    Hosp Univ Rio Hortega Valladolid, Postoperat Crit Care Unit & Reanimat, Valladolid, Spain.
    Ibarz, Mercedes
    Hosp Univ Sagrad Corazon, ICU Hosp Univ Sagrad Corazon, Barcelona, Spain.
    Trenado Alvarez, Josep
    Hosp Univ Mutua Terassa, Intens Care Dept, UCI Semicrit, Terassa, Spain.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sivik, Joakim
    Alingsas Lasarett, IVA Alingsas Lasarett, Alingsas, Sweden.
    Nauska, Jessica
    Blekingesjukhuset Karlskrona, Intensivvardsavdelning 31, Karlskrona, Sweden.
    Smole, Daniel
    Centralsjukhuset & Karlstad, IVA, Karlstad, Sweden.
    Parenmark, Fredric
    Gavle Sjukhus, IVA, Galve, Sweden.
    Lyren, Johanna
    Hudiksvalls Sjukhus, Intensivvardsavdelning, Gavleborg, Sweden.
    Rockstroh, Katalin
    Kalmar Lanssjukhus, IVA, Kalmar, Sweden.
    Ryden, Sara
    Karolinska Univ Hosp Huddinge, Karolinska ICU Huddinge, Huddinge, Sweden.
    Spangfors, Martin
    Intensiven, Kristianstad, Sweden.
    Strinnholm, Morten
    Kungalvs Hosp, ICU Kungalvs Hosp, Kungalv, Sweden.
    Walther, Sten
    Linkoping Univ Hosp, Cardiothorac ICU, Linkoping, Sweden.
    De Geer, Lina
    Linkoping Univ Hosp, ICU, Linkoping, Sweden.
    Nordlund, Peter
    Lanssjukhuset Ryhov, OP IVA Kliniken, Jonkoping, Sweden.
    Palsson, Staffan
    Intensivvardsavdelningen, Norrtalje, Sweden.
    Zetterquist, Harald
    Nykopings Lasarett, IVA, Nykoping, Sweden.
    Nilsson, Annika
    Ornskoldsviks Hosp, Ornskoldsv, IVA, Ornskoldsvik, Sweden.
    Thiringer, Karin
    Sahlgrenska Univ Hosp Molndal, IVA, Avdelning 227, Gothenburg, Sweden.
    Jungner, Marten
    Skane Univ Hosp, ICU SUS Malmo, Lund, Sweden.
    Bark, Bjorn
    Skane Univ Hosp, IVA Lund, Lund, Sweden.
    Nordling, Berit
    IVA Sundsvall, Sundsvall, Sweden.
    Skold, Hans
    Torsby Sjukhus, ICU, Torsby, Sweden.
    Brorsson, Camilla
    Univ Hosp Northern Sweden, CIP, Umea, Sweden.
    Persson, Stefan
    Univ Hosp Orebro, Intensivvarsdavdelningen USO, Orebro, Sweden.
    Bergstrom, Anna
    Vrinnevi Hosp, IVA Vrinnevisjukhuset, Norrkoping, Sweden.
    Berkius, Johan
    Vastervikssjukhus, IVA Vastervikssjukhus, Vastervik, Sweden.
    Holmstrom, Johanna
    Vastmanlands Sjukhus, Intensivvardsavdelningen Vasteras, Vasteras, Sweden.
    van Dijk, I
    Alrijne Ziekenhuis, Intens Care, Leiderdorp, Netherlands.
    van Lelyveld-Haas, L. E. M.
    Diakonessenhuis Utrecht, Intens Care, Utrecht, Netherlands.
    Ramnarain, D.
    Elisabeth Tweesteden Hosp Tilburg, Intens Care, Tilburg, Netherlands.
    Jansen, Tim
    HagaZiekenhuis, Intens Care, The Hague, Netherlands.
    Nooteboom, Fleur
    Laurentius Ziekenhuis, IC LZR, Roermond, Netherlands.
    van der Voort, Peter H. J.
    OLVG, ICU OLVG, Amsterdam, Netherlands.
    de Lange, Dylan
    UMC Utrecht, Dept Intens Care Med, Utrecht, Netherlands.
    Dieperink, Willem
    Univ Med Ctr Groningen, Dept Crit Care, Groningen, Netherlands.
    de Waard, Monique C.
    VU Univ Med Ctr Amsterdam, Intens Care Adults, Amsterdam, Netherlands.
    de Smet, Annemarie G. E.
    Univ Groningen, Univ Med Ctr, Intens Care Unit, Groningen, Netherlands.
    Bormans, Laura
    Zuyderland Med Centrer, Intens Care, Heerlen, Netherlands.
    Dormans, Tom
    Zuyderland Med Centrer, Intens Care, Heerlen, Netherlands.
    Dempsey, Ged
    Aintree Univ Hosp NHS Fdn Trust, Crit Care Unit, Liverpool, Merseyside, England.
    Mathew, Shiju J.
    Alexandra Hosp, ICU, Harlow, Essex, England.
    Raj, Ashok S.
    Batts Hlth NHS Trust, Whipps Cross Hosp, ICU, London, England.
    Grecu, Irina
    Basingstoke & North Hampshire Hosp, ITU HDU, Basingstoke, Hants, England;Royal Hampshire Cty Hosp, ICU, Winchester, Hants, England.
    Cupitt, Jason
    Blackpool Teaching Hosp NHS Fdn Trust, Crit Care Unit, Basingstoke, Hants, England.
    Lawton, Tom
    Bradford Royal Infirm, Crit Care Unit, Bradford, W Yorkshire, England.
    Clark, Richard
    Cent Manchester Fdn Trust, ICU, Manchester, Lancs, England.
    Popescu, Monica
    Chelsea & Westminster Fdn Trust, West Middlesex Univ Hosp, ICU, London, England.
    Spittle, Nick
    Chesterfield Royal Hosp, ICU, Calow, England.
    Faulkner, Maria
    Countess Chester Hosp NHS Fdn Trust, ICU, Chester, Cheshire, England.
    Cowton, Amanda
    Darlington Mem Hosp CDDFT, ICU, Darlington, Durham, England;Univ Hospl North Durham, ICU, Durham, England.
    Elloway, Esme
    Derriford Hosp, ICU, Plymouth, Devon, England.
    Williams, Patricia
    Dorset Cty Hosp, Crit Care Unit, Dorchester, England.
    Reay, Michael
    Russells Hall Hosp, Dudley Grp Hosp NHSFT, Dudley, England.
    Chukkambotla, Srikanth
    East Lancashire Hosp NHS Trust, Crit Care Unit, Burnley, Lancs, England.
    Kumar, Ravi
    East Surrey Hosp, CCU, Redhill, Surrey, England.
    Al-Subaie, Nawaf
    Espsom & St Helier Univ Hosp, ICU, Epsom, Surrey, England.
    Kent, Linda
    Fairfield Hosp, Crit Care Unit, Bury St Edmunds, Suffolk, England;Royal Oldham Hosp, ICU, Oldham, England.
    Tamm, Tiina
    Wexham Pk Hosp, Frimley Hlth, ICU, Slough, Berks, England.
    Kajtor, Istvan
    Frimley Pk Hosp, ICU, Frimley, England.
    Burns, Karen
    Furness Gen, ICU, Barrow In Furness, England.
    Pugh, Richard
    Glan Clwyd Gen Hosp, Crit Care Unit, Bodelwyddan, Wales.
    Ostermann, Marlies
    Guys & St Thomas Hosp, ICU, London, England.
    Kam, Elisa
    Hillingdon Hosp, ICU, Uxbridge, Middx, England.
    Bowyer, Helen
    Hinchingbrooke Healthcare NHS Trust, Crit Care Ctr, Huntingdon, England.
    Smith, Neil
    Hull Royal Infirm, HICU 1&2, Kingston Upon Hull, N Humberside, England.
    Templeton, Maie
    Imperial Coll Healthcare NHS Trust, Crit Care UNIT, London, England.
    Henning, Jeremy
    James Cook Univeristy Hosp, ICU 2 & 3, Middlesbrough, Cleveland, England.
    Goffin, Kelly
    James Paget Univ Hosp, ICU, Great Yarmouth, England.
    Kapoor, Ritoo
    Kent & Canterbury Hosp, K&C ITU, Canterbury, Kent, England.
    Laha, Shondipon
    Lancashire Leaching Hosp NHS Fdn Trust, CrCU, Preston, Lancs, England.
    Chilton, Phil
    Leighton Hosp, Crit Care Unit, Crewe, England.
    Khaliq, Waqas
    Lewisham & Greenwich NHS Trust, ITU HDU, London, England.
    Crayford, Alison
    ITU HDU, Maidstone, Kent, England.
    Coetzee, Samantha
    Medway NHS Fdn Trust, ICU, Gillingham, England.
    Tait, Moira
    Adult ICU, Musgrove Pk, Taunton, Somerset, England.
    Stoker, Wendy
    Northumbria Specialist Emergency Care Hosp, ICU, Cramlington, England.
    Gimenez, Marc
    Papworth Hosp NHS Fdn Trust, ICU, Cambridge, England.
    Pope, Alan
    Peterborough City Hosp, Crit Care Unit, Peterborough, Cambs, England.
    Camsooksai, Julie
    Poole Hosp NHS Trust, Crit Care Unit, Poole, Dorset, England.
    Pogson, David
    Queen Alexandra Hosp Portsmouth, Dept Crit Care, Portsmouth, Hants, England.
    Quigley, Kate
    Queen Elizabeth Hosp, ICU, Birmingham, W Midlands, England.
    Ritzema, Jenny
    Queen Elizabeth Hosp, Crit Care Dept, Gateshead, England.
    Hormis, Anil
    Rotherham NHS Fdn Trust, Crit Care Unit, Rotherham, S Yorkshire, England.
    Boulanger, Carole
    Royal Devon & Exeter NHS Fdn Trust, ICU, Exeter, Devon, England.
    Balasubramaniam, M.
    Royal Bolton NHS Hosp Trust, ICU & HCU, Farnworth, England.
    Vamplew, Luke
    Royal Bournemouth Hosp, Crit Care Unit, Bournemouth, Dorset, England.
    Burt, Karen
    Royal Cornwall Hosp NHS Trust, Crit Care Unit, Truro, England.
    Martin, Daniel
    Royal Free London NHS Fdn Trust, ICU, London, England.
    Craig, Jayne
    Royal Lancaster Infirm, ICU, Lancaster, England.
    Prowle, John
    Royal London Hosp, Adult Crit Care Unit, London, England.
    Doyle, Nanci
    Royal Surrey Cty Hosp, ICU, Guildford, Surrey, England.
    Shelton, Jonathon
    Royal Victoria Infirm, Ward 38 ICU, Newcastle Upon Tyne, Tyne & Wear, England.
    Scott, Carmen
    Royal Victoria Infirm, Ward 18 ICU, Newcastle Upon Tyne, Tyne & Wear, England.
    Donnison, Phil
    Salisbury Dist Hosp, ICU, Salisbury, Wilts, England.
    Shelton, Sarah
    Sherwood Forest Hosp NHS Fdn Trust, ICU, Sutton In Ashfield, England.
    Frey, Christian
    South Tyneside Dist Hosp, ITU HDU, South Shields, England.
    Ryan, Christine
    St George Hosp, GICU, London, England;St Georges Hosp NHS Trust London, Acute Dependency Unit, London, England.
    Spray, Dominic
    St George Hosp, Cardiothorac ICU, London, England.
    Barnes, Veronica
    St Georges Univ Hosp NHS Fdn Trust, Neuro ICU, London, England.
    Barnes, Kerry
    St Helier Hosp, ITU, Sutton, Surrey, England.
    Ridgway, Stephanie
    NHS Fdn Trust, Tameside Gen Hosp, Crit Care Unit, Ashton Under Lyne, England.
    Saha, Rajnish
    Princess Alexandra NHS Hosp, Crit Care Unit, Harlow, Essex, England.
    Clark, Thomas
    Torbay Hosp, ICU, Torquay, England.
    Wood, James
    Tunbridge Wells Hosp, ICU, Pembury, England.
    Bolger, Clare
    Univ Hosp Southampton NHS Fdn Trust, Gen Intens Care, Southampton, Hants, England.
    Bassford, Christopher
    Univ Hosp Coventry, Gen Crit Care, Coventry, W Midlands, England.
    Lewandowski, John
    Univ Hosp North Tees, Crit Care Unit, Stockton On Tees, England.
    Zhao, Xiaobei
    West Hertfortshire NHS Trust, Watford Gen Hosp, ICU, Level 6, Watford, England.
    Humphreys, Sally
    West Suffolk NHS Fdn Trust, Crit Care, Bury St Edmunds, Suffolk, England.
    Dowling, Susan
    Ward 4E Crit Care Unit, Whiston, England.
    Richardson, Neil
    William Harvey Hosp, ICU, Ashford, Kent, England.
    Burtenshaw, Andrew
    Worcestershire Royal Hosp, Crit Care Unit, Worcester, England.
    Stevenson, Carl
    Wye Valley NHS Trust, ICU, Hereford, England.
    Wilcock, Danielle
    York Teaching Hosp NHS Fdn Trust, Crit Care Unit, York, N Yorkshire, England.
    Nalapko, Yuiry
    Lugansk State Med Univ, Anaesthesia & Intens Care, Lugansk, Ukraine.
    A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention2019Ingår i: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 52, s. 141-148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 162.
    Juul, Rasmus Vestergaard
    et al.
    Univ Copenhagen, Dept Drug Design & Pharmacol, DK-2100 Copenhagen, Denmark..
    Rasmussen, Sten
    Aalborg Univ Hosp, Orthopaed Surg Res Unit, Aalborg, Denmark.;Aalborg Univ Hosp, Dept Clin Med, Aalborg, Denmark..
    Kreilgaard, Mads
    Univ Copenhagen, Dept Drug Design & Pharmacol, DK-2100 Copenhagen, Denmark..
    Christrup, Lona Louring
    Univ Copenhagen, Dept Drug Design & Pharmacol, DK-2100 Copenhagen, Denmark..
    Simonsson, Ulrika S. H.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Lund, Trine Meldgaard
    Univ Copenhagen, Dept Drug Design & Pharmacol, DK-2100 Copenhagen, Denmark..
    Repeated Time-to-event Analysis of Consecutive Analgesic Events in Postoperative Pain2015Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 123, nr 6, s. 1411-1419Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Reduction in consumption of opioid rescue medication is often used as an endpoint when investigating analgesic efficacy of drugs by adjunct treatment, but appropriate methods are needed to analyze analgesic consumption in time. Repeated time-to-event (RTTE) modeling is proposed as a way to describe analgesic consumption by analyzing the timing of consecutive analgesic events. Methods: Retrospective data were obtained from 63 patients receiving standard analgesic treatment including morphine on request after surgery following hip fracture. Times of analgesic events up to 96 h after surgery were extracted from hospital medical records. Parametric RTTE analysis was performed with exponential, Weibull, or Gompertz distribution of analgesic events using NONMEM (R), version 7.2 (ICON Development Solutions, USA). The potential influences of night versus day, sex, and age were investigated on the probability. Results: A Gompertz distribution RTTE model described the data well. The probability of having one or more analgesic events within 24 h was 80% for the first event, 55% for the second event, 31% for the third event, and 18% for fourth or more events for a typical woman of age 80 yr. The probability of analgesic events decreased in time, was reduced to 50% after 3.3 days after surgery, and was significantly lower (32%) during night compared with day. Conclusions: RTTE modeling described analgesic consumption data well and could account for time-dependent changes in probability of analgesic events. Thus, RTTE modeling of analgesic events is proposed as a valuable tool when investigating new approaches to pain management such as opioid-sparing analgesia.

  • 163.
    Jönsson, Sofia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    Melville, Jacqueline
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi.
    Hultström, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi.
    Norepinephrine effects are not affected by Losartan in rats after resuscitated haemorrhage2017Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, nr 8, s. 963-963Artikel i tidskrift (Övrigt vetenskapligt)
  • 164.
    Kalman, Sigridur
    et al.
    Karolinska Univ Hosp, Huddinge, Sweden..
    Wiklund, Andreas
    Karolinska Univ Hosp, Solna, Sweden..
    Semenas, Egidijus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nilsson, Lena
    Uppsala Univ Hosp, Uppsala, Sweden..
    Brattstrom, Olof
    Uppsala Univ Hosp, Uppsala, Sweden..
    Bjorne, Hakan
    Uppsala Univ Hosp, Uppsala, Sweden..
    Bell, Max
    Uppsala Univ Hosp, Uppsala, Sweden..
    Ahlstrand, Rebecca
    Orebro Univ Hosp, Orebro, Sweden..
    Bartha, Erzsebet
    Karolinska Univ Hosp, Huddinge, Sweden..
    Postoperative complications in high-risk surgical patients - predictors, risk factors, and outcomes following major surgery study (PROFS study NCT02626546): validation of three prediction models2017Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, nr 8, s. 1056-1056Artikel i tidskrift (Övrigt vetenskapligt)
  • 165. Kanstrup, M.
    et al.
    Holmstrom, L.
    Ringström, R.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Wicksell, R. K.
    Insomnia in paediatric chronic pain and its impact on depression and functional disability2014Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 18, nr 8, s. 1094-1102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Children and adolescents attending health care due to chronic pain commonly presents with insomnia. Previous research suggests that problems with sleep are associated with depression and functional disability. However, more research is needed to clarify the relationship between pain, insomnia and disability. Objective: This study aims to investigate the frequency, severity and importance of insomnia in paediatric patients with chronic pain and to evaluate the mediating role of insomnia in explaining the relationship between pain and depression as well as between pain and functioning. In addition, to ascertain the adequacy of using a Swedish translation of the Insomnia Severity Index (ISI) with youths, analyses included a statistical evaluation of the instrument. Method: Correlational analyses of cross-sectional data from 154 consecutive paediatric patients with chronic pain referred to a tertiary pain clinic. Results: Insomnia explained a significant amount of variance in depression and functional disability when controlling for demographic characteristics and pain. Indirect effects of insomnia were found for both the relationship between pain and depression, and between pain and functional disability. ISI showed satisfactory psychometric properties in this sample, including internal consistency and concurrent criteria validity. Conclusions: Insomnia is highly important in explaining depression and functional disability in paediatric chronic pain and can be adequately assessed using the ISI.

  • 166. Karagiannidis, C.
    et al.
    Kampe, K. Aufm
    Sipmann, F. Suarez
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Larsson, Anders
    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.
    Hedenstierna, Görna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Windisch, W.
    Mueller, T.
    Pathophysiology and technical Prerequisites of veno-venous extracorporal C0(2) Elimination(ECCO2R) to the treatment of difficult respiratory Acidosis2015Ingår i: MEDIZINISCHE KLINIK-INTENSIVMEDIZIN UND NOTFALLMEDIZIN, ISSN 2193-6218, Vol. 110, nr 4, s. 311-311Artikel i tidskrift (Övrigt vetenskapligt)
  • 167.
    Karlsson, Victoria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Sporre, Bengt
    Univ Uppsala Hosp, Unit Pediat Anesthesia, Uppsala, Sweden..
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Transcutaneous Pco(2) Monitoring in. Newborn Infants During General Anesthesia Is Technically Feasible2016Ingår i: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 123, nr 4, s. 1004-1007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Transcutaneous (TC) measurement of Pco(2) (TC Pco(2)) is a well-established method to monitor assisted ventilation in neonatal intensive care, but its use in the operating room is limited, and the data regarding its performance during general anesthesia of the newborn are lacking. The aim of this study is to evaluate the performance of continuous TC Pco(2) monitoring during general anesthesia in newborn infants. METHODS: Infants (n = 25) with a gestational age of 23 to 41 weeks and a birth weight of 548 to 4114 g were prospectively enrolled. During general anesthesia and surgery, TC Pco(2) was measured continuously and recorded at 1-minute intervals. Five-minute mean values were compared with simultaneously obtained blood gas (BG) analyses of Pco(2). Only the first paired TC and BG samples were used in this analysis. We defined precision as 2.1 times the standard deviation of the difference of the 2 samples. P < .01 was considered statistically significant. RESULTS: We obtained samples from 25 infants. The difference between TC and BG was 0.3 +/- 0.7 kPa (mean +/- standard deviation) giving a precision of 1.47 kPa. Nineteen of twenty-five (76%) sample pairs displayed a difference of <1 kPa (99% confidence interval, 48%-92%, P = .016). The difference in paired samples was similar for different gestational and postnatal ages and did not appear to be affected by electrocautery. CONCLUSIONS: In this small study, we did not demonstrate that TC CO2 monitoring was accurate at P < .01. This partly reflects the small size of the study, resulting in wide 99% confidence bounds.

  • 168.
    Karlsson, Victoria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sporre, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible2016Ingår i: Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, Vol. 123, nr 4, s. 1004-1007, artikel-id 10.1213/ANE.0000000000001462Artikel i tidskrift (Refereegranskat)
  • 169.
    Kawati, Rafael
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Evaluation of Respiratory Mechanics by Flow Signal Analysis: With Emphasis on Detecting Partial Endotracheal Tube Obstruction During Mechanical Ventilation2006Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Evaluating respiratory mechanics during dynamic conditions without interrupting ongoing ventilation and flow, adds to the information obtained from the mechanics derived from static (= no flow) conditions, i.e., the flow signal has the potential to provide information on the properties of the respiratory system (including the tubing system). Hence monitoring the changes in the flow signal during ongoing mechanical ventilation would give information about the dynamic mechanics of the respiratory system. Any change in the mechanics of the respiratory system including the endotracheal tube (ETT) and the ventilatory circuit would affect the shape of the flow signal.

    Knowledge of the airway pressure distal to the ETT at the carina level (= tracheal pressure) is required for calculating the extra resistive load exerted by the endotracheal tube in order to compensate for it. In a porcine model, the flow signal was used to non-invasively calculate tracheal pressure. There was good agreement between calculated and measured tracheal pressure with different modes of ventilation. However, calculation of tracheal pressure assumes that the inner diameter of the ETT is known, and this assumption is not met if the inner diameter is narrowed by secretions. Flow that passes a narrowed tube is decelerated and this is most pronounced with the high flow of early expiration, yielding a typical time constant over expiratory volume pattern that is easy to recognize during mechanical ventilation. This pattern reliably detected partial endotracheal obstruction during volume and pressure controlled mechanical ventilation.

    A change in compliance of the respiratory system modifies the elastic recoil and this also affects the rate of the expiratory flow and the shape of its signal. In a porcine model, lung volume gains on the flow signal generated by the heartbeats (cardiogenic oscillations) provided information about the compliance of the respiratory system during ongoing mechanical ventilation

    In conclusion analyzing the flow signal during ongoing ventilation can be a cheap, non-invasive and reliable tool to monitor the elastic and resistive properties of the respiratory system including the endotracheal tube.

    Delarbeten
    1. Good short-term agreement between measured and calculated tracheal pressure
    Öppna denna publikation i ny flik eller fönster >>Good short-term agreement between measured and calculated tracheal pressure
    Visa övriga...
    2003 (Engelska)Ingår i: British Journal of Anaesthesia, Vol. 91, nr 3, s. 239-248Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-94023 (URN)
    Tillgänglig från: 2006-02-22 Skapad: 2006-02-22 Senast uppdaterad: 2015-06-11Bibliografiskt granskad
    2. Peak airway pressure increase is late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign
    Öppna denna publikation i ny flik eller fönster >>Peak airway pressure increase is late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign
    Visa övriga...
    2005 (Engelska)Ingår i: Anesthesia and Analgesia, Vol. 100, nr 3, s. 889-893Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-94024 (URN)
    Tillgänglig från: 2006-02-22 Skapad: 2006-02-22 Senast uppdaterad: 2015-06-11Bibliografiskt granskad
    3. Change in expiratory flow can early detect partial endotracheal tube obstruction in pressure controlled ventilation
    Öppna denna publikation i ny flik eller fönster >>Change in expiratory flow can early detect partial endotracheal tube obstruction in pressure controlled ventilation
    Visa övriga...
    (Engelska)Artikel i tidskrift (Refereegranskat) Submitted
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-94025 (URN)
    Tillgänglig från: 2006-02-22 Skapad: 2006-02-22 Senast uppdaterad: 2015-06-11Bibliografiskt granskad
    4. cardiogenic oscillations reflects decreasing compliance of the respiratory system during long-term ventilation
    Öppna denna publikation i ny flik eller fönster >>cardiogenic oscillations reflects decreasing compliance of the respiratory system during long-term ventilation
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    2004 (Engelska)Ingår i: Journal of Applied physiology, Vol. 96, nr 3, s. 879-884Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-94026 (URN)
    Tillgänglig från: 2006-02-22 Skapad: 2006-02-22 Senast uppdaterad: 2015-06-11Bibliografiskt granskad
  • 170.
    Kiiski, Heikki
    et al.
    Tampere Univ Hosp, Dept Intens Care, Crit Care Med Res Grp, Tampere, Finland..
    Jalkanen, Ville
    Tampere Univ Hosp, Dept Intens Care, Crit Care Med Res Grp, Tampere, Finland..
    Ala-Peijari, Marika
    Tampere Univ Hosp, Dept Intens Care, Crit Care Med Res Grp, Tampere, Finland..
    Hamalainen, Mari
    Univ Tampere, Tampere Univ Hosp, Fac Med & Life Sci, Immunopharmacol Res Grp, Tampere, Finland..
    Moilanen, Eeva
    Univ Tampere, Tampere Univ Hosp, Fac Med & Life Sci, Immunopharmacol Res Grp, Tampere, Finland..
    Peltola, Jukka
    Univ Tampere, Tampere Univ Hosp, Dept Neurol, Tampere, Finland..
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Tampere Univ Hosp, Dept Intens Care, Crit Care Med Res Grp, Tampere, Finland..
    Plasma soluble Urokinase-Type Plasminogen activator receptor is not associated with neurological Outcome in Patients with aneurysmal subarachnoid hemorrhage2017Ingår i: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 8, artikel-id 144Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Object: Aneurysmal subarachnoid hemorrhage (aSAH) is a common cause of death or long-term disability. Despite advances in neurocritical care, there is still only a very limited ability to monitor the development of secondary brain injury or to predict neurological outcome after aSAH. Soluble urokinase-type plasminogen activator receptor (suPAR) has shown potential as a prognostic and as an inflammatory biomarker in a wide range of critical illnesses since it displays an association with overall immune system activation. This is the first time that suPAR has been evaluated as a prognostic biomarker in aSAH. Methods: In this prospective population-based study, plasma suPAR levels were measured in aSAH patients (n = 47) for up to 5 days. suPAR was measured at 0, 12, and 24 h after patient admission to the intensive care unit (ICU) and daily thereafter until he/ she was transferred from the ICU. The patients' neurological outcome was evaluated with the modified Rankin Scale (mRS) at 6 months after aSAH. Results: suPAR levels (n = 47) during the first 24 h after aSAH were comparable in groups with a favorable (mRS 0-2) or an unfavorable (mRS 3-6) outcome. suPAR levels during the first 24 h were not associated with the findings in the primary brain CT, with acute hydrocephalus, or with antimicrobial medication use during 5-days' follow-up. suPAR levels were associated with generally accepted inflammatory biomarkers (C-reactive protein, leukocyte count). Conclusion: Plasma suPAR level was not associated with either neurological outcome or selected clinical conditions. While suPAR is a promising biomarker for prognostication in several conditions requiring intensive care, it did not reveal any value as a prognostic biomarker after aSAH.

  • 171. Kirkpatrick, Andrew W
    et al.
    De Waele, Jan J
    De Laet, Inneke
    De Keulenaer, Bart L
    D'Amours, Scott
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Balogh, Zsolt J
    Leppäniemi, Ari
    Kaplan, Mark
    Chiaka Ejike, Janeth
    Reintam Blaser, Annika
    Sugrue, Michael
    Ivatury, Rao R
    Malbrain, Manu L N G
    WSACS--The Abdominal Compartment Society. A Society dedicated to the study of the physiology and pathophysiology of the abdominal compartment and its interactions with all organ systems.2015Ingår i: Anaesthesiology intensive therapy, ISSN 1731-2515, Vol. 47, nr 3, s. 191-194Artikel i tidskrift (Refereegranskat)
  • 172.
    Kirkpatrick, Andrew W.
    et al.
    EG 23 Foothills Med Ctr, Reg Trauma Serv, Calgary, AB T2N 2T9, Canada..
    Roberts, Derek J.
    Univ Calgary, Dept Surg, Calgary, AB, Canada.;Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada..
    Jaeschke, Roman
    McMaster Univ, Dept Med, Hamilton, ON, Canada.;McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada..
    De Waele, Jan
    Ghent Univ Hosp, Dept Crit Care Med, Ghent, Belgium.;Ghent Med Sch, Ghent, Belgium..
    De Keulenaer, Bart
    Fremantle Hosp, Intens Care Unit, Fremantle, WA, Australia..
    Duchesne, Juan
    Anesthesia & Emergency Med, Div Surg, Sect Trauma & Crit Care Surg, Tulane Surg Intens Care Unit, New Orleans, LA USA..
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Leppaniemi, Ari
    Univ Helsinki, Meilahti Hosp, Dept Abdominal Surg, Haartmaninkatu, Hus, Finland..
    Ejike, Janeth C.
    Loma Linda Univ, Childrens Hosp, Loma Linda, CA 92350 USA..
    Sugrue, Michael
    Letterkenny Hosp, Dept Surg, Donegal, Ireland.;Univ Coll Hosp, Galway, Ireland..
    Cheatham, Michael
    Dept Surg Educ, Orlando, FL USA..
    Ivatury, Rao
    Virginia Commonwealth Univ Med Coll Virginia, Richmond, VA USA..
    Ball, Chad G.
    EG 23 Foothills Med Ctr, Reg Trauma Serv, Calgary, AB T2N 2T9, Canada..
    Blaser, Annika Reintam
    Univ Tartu, Clin Anaesthesiol & Intens Care, EE-50090 Tartu, Estonia..
    Regli, Adrian
    Fremantle Hosp, Intens Care Unit, Fremantle, WA, Australia.;Sch Med & Pharmacol, Crawley, WA, Australia.;Univ Notre Dame, Fremantle, WA, Australia..
    Balogh, Zsolt J.
    Univ Newcastle, John Hunter Hosp, Newcastle, NSW 2300, Australia..
    D'Amours, Scott
    Liverpool Hosp, Trauma Dept, Liverpool, NSW, Australia..
    De Iaet, Inneke
    ZNA Stuivenberg, Ziekenhuis Netwerk Antwerpen, Intens Care Unit, Antwerp, Belgium.;ZNA Stuivenberg, Ziekenhuis Netwerk Antwerpen, High Care Burn Unit, Antwerp, Belgium..
    Malbrain, Manu L. N. G.
    ZNA Stuivenberg, Ziekenhuis Netwerk Antwerpen, Intens Care Unit, Antwerp, Belgium.;ZNA Stuivenberg, Ziekenhuis Netwerk Antwerpen, High Care Burn Unit, Antwerp, Belgium..
    Methodological background and strategy for the 2012-2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society2015Ingår i: ANAESTHESIOLOGY INTENSIVE THERAPY, ISSN 1642-5758, Vol. 47, s. S63-S77Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH//ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format. Scientific consultations were obtained from Methodological GRADE experts and a series of educational teleconferences were conducted to educate scientific review teams from among the wscacs. org membership. Each team conducted systematic or structured reviews to identify relevant studies and prepared evidence summaries and draft Grades of Recommendation Assessment, Development and Evaluation (GRADE) recommendations. The evidence and draft recommendations were presented and debated in person over four days. Updated consensus definitions and management statements were derived using a modified Delphi method. A writing committee subsequently compiled the results utilizing frequent Internet discussion and Delphi voting methods to compile a robust online Master Report and a concise peer-reviewed summarizing publication. A dedicated Paediatric Guidelines Subcommittee reviewed all recommendations and either accepted or revised them for appropriateness in children. Of the original 12 IAH/ACS definitions proposed in 2006, three (25%) were accepted unanimously, with four (33%) accepted by >80%, and four (33%) accepted by >50%, but required discussion to produce revised definitions. One (8%) was rejected by >50%. In addition to previous 2006 definitions, the panel also defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, abdominal compliance, and suggested a refined open abdomen classification system. Recommendations were possible regarding intra-abdominal pressure (IAP) measurement, approach to sustained IAH, philosophy of protocolized IAP management and same-hospital-stay fascial closure, use of decompressive laparotomy, and negative pressure wound therapy. Consensus suggestions included use of non-invasive therapies for treating IAH/ACS, considering body position and IAP, damage control resuscitation, prophylactic open abdomen usage, and prudence in early biological mesh usage. No recommendations were made for the use of diuretics, albumin, renal replacement therapies, and utilizing abdominal perfusion pressure as a resuscitation-endpoint. Collaborating Methodological Guideline Development and Clinical Experts produced Consensus Definitions/Clinical Management statements encompassing the most contemporary evidence. Data summaries now exist for clinically relevant IAH/ACS questions, which will facilitate future scientific reanalysis.

  • 173.
    Kjellman, Britt-Marie
    et al.
    Inst för klinisk och experimentell medicin.
    Mats, Fredriksson
    Inst för klinisk och experimentell medicin.
    Glad Mattson, Gunilla
    Inst för klinisk och experimentell medicin.
    Sjöberg, Folke
    Inst för klinisk och experimentell medicin.
    Huss, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Comparing ambient, air-convection, and fluid-convection heating techniques in treating hypothermic burn patients, a clinical RCT2011Ingår i: Annals of Surgical Innovation and Research, ISSN 1750-1164, Vol. 5, nr 1, s. 4-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Hypothermia in burns is common and increases morbidity and mortality. Several methods are available to reach and maintain normal core body temperature, but have not yet been evaluated in critical care for burned patients. Our unit's ordinary technique for controlling body temperature (Bair Hugger®+ radiator ceiling + bed warmer + Hotline®) has many drawbacks e.g.; slow and the working environment is hampered.The aim of this study was to compare our ordinary heating technique with newly-developed methods: the Allon™2001 Thermowrap (a temperature regulating water-mattress), and Warmcloud (a temperature regulating air-mattress).

    METHODS:

    Ten consecutive burned patients (> 20% total burned surface area and a core temperature < 36.0°C) were included in this prospective, randomised, comparative study. Patients were randomly exposed to 3 heating methods. Each treatment/measuring-cycle lasted for 6 hours. Each heating method was assessed for 2 hours according to a randomised timetable. Core temperature was measured using an indwelling (bladder) thermistor. Paired t-tests were used to assess the significance of differences between the treatments within the patients. ANOVA was used to assess the differences in temperature from the first to the last measurement among all treatments. Three-way ANOVA with the Tukey HSD post hoc test and a repeated measures ANOVA was used in the same manner, but included information about patients and treatment/measuring-cycles to control for potential confounding. Data are presented as mean (SD) and (range). Probabilities of less than 0.05 were accepted as significant.

    RESULTS:

    The mean increase, 1.4 (SD 0.6°C; range 0.6-2.6°C) in core temperature/treatment/measuring-cycle highly significantly favoured the Allon™2001 Thermowrap in contrast to the conventional method 0.2 (0.6)°C (range -1.2 to 1.5°C) and the Warmcloud 0.3 (0.4)°C (range -0.4 to 0.9°C). The procedures for using the Allon™2001 Thermowrap were experienced to be more comfortable and straightforward than the conventional method or the Warmcloud.

    CONCLUSIONS:

    The Allon™2001 Thermowrap was more effective than the Warmcloud or the conventional method in controlling patients' temperatures.

  • 174.
    Klarin, Bengt
    et al.
    Lund Univ, Dept Anaesthesiol & Intens Care, Lund, Sweden; Skåne Univ Hosp, Lund, Sweden.
    Adolfsson, Anne
    Lund Univ, Dept Anaesthesiol & Intens Care, Lund, Sweden; Skåne Univ Hosp, Lund, Sweden.
    Torstensson, Anders
    Cty Hosp, Dept Anaesthesiol, Halmstad, Sweden.
    Larsson, Anders
    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.
    Can probiotics be an alternative to chlorhexidine for oral care in the mechanically ventilated patient? A multicentre, prospective, randomised controlled open trial2018Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 22, artikel-id 272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Pathogenic enteric bacteria aspirated from the oropharynx are the main cause of ventilator-associated pneumonia (VAP). Using chlorhexidine (CHX) orally or selective decontamination has been shown to reduce VAP. In a pilot study we found that oral care with the probiotic bacterium Lactobacillus plantarum 299 (Lp299) was as effective as CHX in reducing enteric bacteria in the oropharynx. To confirm those results, in this expanded study with an identical protocol we increased the number of patients and participating centres.

    Methods: One hundred and fifty critically ill patients on mechanical ventilation were randomised to oral care with either standard 0.1% CHX solution (control group) or a procedure comprising final application of an emulsion of Lp299. Samples for microbiological analyses were taken from the oropharynx and trachea at inclusion and subsequently at defined intervals.

    Student’s t test was used for comparisons of parameters recorded daily and Fisher’s exact test was used to compare the results of microbiological cultures.

    Results: Potentially pathogenic enteric bacteria not present at inclusion were identified in oropharyngeal samples from 29 patients in the CHX group and in 31 samples in the probiotic group. Considering cultures of tracheal secretions, enteric bacteria were found in 17 and 19 samples, respectively. Risk ratios show a difference in favour of the Lp group for fungi in oropharyngeal cultures. VAP was diagnosed in seven patients in the Lp group and in 10 patients among the controls.

    Conclusions: In this multicentre study, we could not demonstrate any difference between Lp299 and CHX used in oral care procedures regarding their impact on colonisation with emerging potentially pathogenic enteric bacteria in the oropharynx and trachea.

    Trial registration: ClinicalTrials.gov, NCT01105819. Registered on 9 April 2010. First part: Current Controlled Trials, ISRCTN00472141. Registered on 22 November 2007 (published Critical Care 2008, 12:R136).

  • 175. Klarin, Bengt
    et al.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Molin, Göran
    Jeppsson, Bengt
    Susceptibility to antibiotics in isolates of Lactobacillus plantarum RAPD-type Lp299v, harvested from antibiotic treated, critically ill patients after administration of probiotics.2019Ingår i: MicrobiologyOpen, ISSN 2045-8827, E-ISSN 2045-8827, Vol. 8, nr 2, artikel-id e00642Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Recultured Lactobacillus plantarum 299v-like strains were tested regarding antibiotic susceptibility, and no decrease was detected. Antibiotics are frequently used to treat patients in intensive care units (ICUs) and are associated with a significant risk of selection of resistant bacterial strains. In particular, it is possible that genetic transfer of antibiotic resistance to the resident gastrointestinal flora, as well as to administered probiotics, may be increased in the ICU setting. The aim of the present investigation was to detect possible changes in antimicrobial susceptibility in reisolates of the probiotic strain Lactobacillus plantarum 299v (Lp299v) given to antibiotic treated, critically ill patients. Lp299v-like strains were identified in cultures of biopsies and fecal samples from 32 patients given the probiotic strain enterally in two previous ICU studies. The patients received a variety of antibiotics. Isolates with the same genomic RAPD profile (RAPD-type) as Lp299v were obtained to enable monitoring of antibiotic susceptibility by E-tests. Forty-two isolates, collected throughout the course of illness, were tested against 22 different antibiotics. No obvious decrease in susceptibility was found for 21 of the tested antibiotics. There was a tendency toward decreased susceptibility to ampicillin. The stable antibiotic susceptibility profiles of the Lp299v-like isolates studied here suggests this probiotic is less likely to acquire resistance when administered to critically ill patients treated with broad-spectrum antibiotics.

  • 176. Knapik, Piotr
    et al.
    Krzych, Łukasz J
    Weigl, Wojciech
    Adamski, Jan
    Hultström, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Mortality rate in Polish intensive care units is lower than predicted according to the APACHE II scoring system.2017Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, s. 1745-1746Artikel i tidskrift (Övrigt vetenskapligt)
  • 177.
    Kneiszl, Rosita
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    The Volatile Anesthetic Sevoflurane and Alterations in Neural Activity, as Measured by the Neural Regulated Protein ARC2015Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: General anesthesia, performed in surgery, reduces the neural activity. Sevoflurane is the most commonly used inhalation anesthetic in clinical. In the present study, the activity-regulated cytoskeleton-associated protein ARC is used to measure the alterations in neural activity from an exposure to sevoflurane. ARC is involved in the consolidation of long-term memory, and induced by exploration of novelty. It is unknown how long time it takes for the brain to recover to its baseline state of neuronal activity after a treatment with a general anesthetic.

    Hypothesis: We hypothesize the neural activity to be decreased during the treatment, and increased above baseline after recovery.

    Methods: Seventeen mice, divided in five groups, were studied and euthanized at different time points. The baseline group was euthanized prior to any treatment. The other groups either received sevoflurane or oxygen for three hours with half of the animals euthanized at the end of the treatment, and the other groups were allowed three hours recovery.

    Results: A significant difference was shown between the anesthetized groups and the control groups when comparing the number of ARC expressing cells per unit area (P = 0.0472). There were no significant differences on the other measurements (P > 0.05), except for the mean intensity when comparing baseline and control group at the end of treatment (P = 0.0251). The neural activity in the anesthetized mice was decreased during the exposure, and this change persisted for at least 3 hours after recovery.

    Conclusions: Sevoflurane decreases neural activity, as measured by the ARC protein in the dentate gyrus. Further studies are required to determine the duration of ARC expression depression after treatment with sevoflurane.

  • 178.
    Knudsen, Kati
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Airway management in anaesthesia care: – professional and patient perspectives2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Careful airway management, including tracheal intubation, is important when performing anaesthesia in order to achieve safe tracheal intubation. Aim: To study airway management in anaesthesia care from both the professional and patient perspectives. Methods: 11 RNAs performed three airway tests in 87 patients, monitored in a study-specific questionnaire. The tests usefulness for predicting an easy intubation was analysed (Study I). 68 of 74 anaesthesia departments in Sweden answered a self-reported questionnaire about the presence of airway guidelines (Study II). 20 anaesthesiologists were interviewed; a phenomenographic analysis was performed to describe how anaesthesiologists' understand algorithms for management of the difficult airway (Study III). 13 patients were interviewed; content analysis was performed to describe patients' experiences of being awake fiberoptic intubated (Study IV). Results: The Mallampati classification is a good screening test for predicting easy intubation and intubation can be safely performed by RNAs (Study I). The presence of airway guidelines in Swedish anaesthesia departments is poorly implemented (Study II). Algorithms can be understood as law-like rules, a succinct plan to follow in difficult airway situations, an action plan kept in the back of one's mind while creating flexible and versatile personal algorithms, or as consensus guidelines based on expert opinion in order to be followed in clinical practice (Study III). One theme emerged describing experiences of being awake intubated; feelings of being in a vulnerable situation but cared for in safe hands, described in five categories: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation (Study IV). Conclusions: The Mallampati classification is a good screening test for predicting easy intubation, when the airway assessment is performed in a structured manner by RNAs. The presence of airway guidelines in Swedish anaesthesia departments was poorly implemented and should receive higher priority. Algorithms need to be simple and easy to follow and based on the best available scientific evidence. Tailored information about what to expect, ensuring eye contact, and giving breathing instructions during the procedure may reduce patients' feeling distress.

    Delarbeten
    1. The best method to predict easy intubation: a quasi-experimental pilot study
    Öppna denna publikation i ny flik eller fönster >>The best method to predict easy intubation: a quasi-experimental pilot study
    2014 (Engelska)Ingår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 29, nr 4, s. 292-297Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    PURPOSE:

    To facilitate evaluation of the airway before endotracheal intubation, different scores have been developed, mainly to predict difficult airways. However, in anesthesia clinical practice in Sweden, scores would be more useful if they could also predict an easy airway, so that the correct category of anesthesia personnel can be allocated. Therefore, we evaluated whether scoring systems commonly used to predict difficult airways could also predict easy endotracheal intubation.

    DESIGN:

    This prospective observational study included patients who were scheduled for general anesthesia and required endotracheal intubation.

    METHODS:

    Airways were evaluated preoperatively by two independent variables, namely Mallampati classification and thyromental distance. After anesthesia induction, the Cormack and Lehane grade was assessed.

    FINDING:

    Mallampati scores yielded the highest specificity in predicting easy intubation, and Cormack and Lehane grades yielded the highest positive predictive value for predicting easy intubation.

    CONCLUSIONS:

    Mallampati classification is an appropriate screening test for predicting easy intubation.

    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-231850 (URN)10.1016/j.jopan.2013.05.015 (DOI)000340344000005 ()25062573 (PubMedID)
    Tillgänglig från: 2014-09-10 Skapad: 2014-09-10 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    2. A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden
    Öppna denna publikation i ny flik eller fönster >>A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden
    Visa övriga...
    2014 (Engelska)Ingår i: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, s. 25-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background

    In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

    Methods

    A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

    Results

    In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.

    Conclusions

    Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Medicinsk vetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-223660 (URN)10.1186/1471-2253-14-25 (DOI)000335076000001 ()
    Tillgänglig från: 2014-04-23 Skapad: 2014-04-23 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    3. Anaesthesiologists understanding of algorithms for management of the difficult airway- a qualitative interview study
    Öppna denna publikation i ny flik eller fönster >>Anaesthesiologists understanding of algorithms for management of the difficult airway- a qualitative interview study
    Visa övriga...
    (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Artikel i tidskrift (Refereegranskat) Submitted
    Nyckelord
    airway algorithm, qualitative study
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-281380 (URN)
    Tillgänglig från: 2016-03-30 Skapad: 2016-03-23 Senast uppdaterad: 2017-11-30
    4. Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study
    Öppna denna publikation i ny flik eller fönster >>Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study
    2016 (Engelska)Ingår i: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, artikel-id 71Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. Methods A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories. Results From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff’s competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals’ expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself. Conclusions Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

    Nyckelord
    Awake fiberoptic intubation, Anaesthesia care, Qualitative study
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:uu:diva-281381 (URN)10.1186/s12871-016-0240-z (DOI)000382199100004 ()27576876 (PubMedID)
    Tillgänglig från: 2016-03-30 Skapad: 2016-03-23 Senast uppdaterad: 2017-11-30Bibliografiskt granskad
  • 179.
    Knudsen, Kati
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    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.
    Nilsson, Ulrica
    The best method to predict easy intubation: a quasi-experimental pilot study2014Ingår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 29, nr 4, s. 292-297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    To facilitate evaluation of the airway before endotracheal intubation, different scores have been developed, mainly to predict difficult airways. However, in anesthesia clinical practice in Sweden, scores would be more useful if they could also predict an easy airway, so that the correct category of anesthesia personnel can be allocated. Therefore, we evaluated whether scoring systems commonly used to predict difficult airways could also predict easy endotracheal intubation.

    DESIGN:

    This prospective observational study included patients who were scheduled for general anesthesia and required endotracheal intubation.

    METHODS:

    Airways were evaluated preoperatively by two independent variables, namely Mallampati classification and thyromental distance. After anesthesia induction, the Cormack and Lehane grade was assessed.

    FINDING:

    Mallampati scores yielded the highest specificity in predicting easy intubation, and Cormack and Lehane grades yielded the highest positive predictive value for predicting easy intubation.

    CONCLUSIONS:

    Mallampati classification is an appropriate screening test for predicting easy intubation.

  • 180.
    Knudsen, Kati
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Högskolan i Gävle, University of Gävle.
    Pöder, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi. 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 kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nilsson, Ulrica
    Örebro universitet, Örebro University.
    A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden2014Ingår i: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, s. 25-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.

    Methods

    A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.

    Results

    In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesia record form were dental status and head and neck mobility.

    Conclusions

    Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority.

  • 181.
    Koga, Itaru
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Monitoring of Splanchnic Regional Perfusion: An Experimental Study of New Application and Validation2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Systemic infection, major surgery, trauma and many other causes can lead to impaired organ function. Compensated shock is not detected by global hemodynamic and oxygen measurements, as they take no account for regional variations. Focus has therefore gradually turned from looking at systemic changes to selective investigations of regional blood flow and ischemia. This thesis presents a series of experiments evaluating new application and validation of various monitoring techniques.

    An experimental porcine model with anesthetized and invasively monitored animals was used. The circulatory interventions included endotoxin infusion (septic shock), aortic constriction and selective clamping of splanchnic arteries. The aim was to compare air with saline tonometry, to validate the intraperitoneal use of tonometry and to reexamine the use of endoluminal reflectance pulse oxymetry. To investigate the relative contributions of regional blood flow and detection of ischemia, measurements of hepatic venous oxygen saturation (ShvO2), lactate concentrations and PCO2 gap were used.

    Our findings support the use of air instead of saline as the preferred technique for tonometric measurements. With the intraperitoneal application of tonometry we gain more information on regional aspects of the splanchnic circulation, and it appears to be a reliable monitoring option for early detection of ischemia in the small intestine. Measurements of ShvO2 will give an overall reflection of the intestinal circulation. The sigmoid colonic pulse oximetry showed a non-linear response in relation to regional blood flow, and will therefore not be able to detect gradual changes in oxygen saturation. Determination of the regional to endtidal PCO2 gap might prove valuable for monitoring of the intestinal circulation.

    Because of sophisticated interactions between portal and hepatic arterial blood flow and hepatic compensation for regional ischemia, a combination of monitoring techniques might be needed. The results of this study will hopefully encourage clinical evaluation of intraperitoneal tonometry and endtidal PCO2 gap recordings for non-invasive, semi-continuous, trend monitoring of the splanchnic circulation.

    Delarbeten
    1. Intraperitoneal and sigmoid colon tonometry in porcine hypoperfusion and endotoxin shock models
    Öppna denna publikation i ny flik eller fönster >>Intraperitoneal and sigmoid colon tonometry in porcine hypoperfusion and endotoxin shock models
    1999 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 43, nr 7, s. 702-707Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-90926 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16 Senast uppdaterad: 2015-06-09Bibliografiskt granskad
    2. Intraperitoneal tonometry for detection of regional enteric ischemia
    Öppna denna publikation i ny flik eller fönster >>Intraperitoneal tonometry for detection of regional enteric ischemia
    2000 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 44, nr 8, s. 985-990Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-90927 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16 Senast uppdaterad: 2015-06-09Bibliografiskt granskad
    3. Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
    Öppna denna publikation i ny flik eller fönster >>Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
    2002 Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 46, nr 10, s. 1212-1216Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-90928 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16Bibliografiskt granskad
    4. Experimental evaluation of hepatic venous oxygen saturation and lactate measurements in varying splanchnic perfusion
    Öppna denna publikation i ny flik eller fönster >>Experimental evaluation of hepatic venous oxygen saturation and lactate measurements in varying splanchnic perfusion
    (Engelska)Manuskript (Övrigt vetenskapligt)
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-90929 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16 Senast uppdaterad: 2015-06-09Bibliografiskt granskad
  • 182.
    Kostic, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    New methods for optimization of mechanical ventilation2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Mechanical ventilation saves lives, but it is an intervention fraught with the potential for serious complications. Prevention of these complications has become the focus of research and critical care in the last twenty years. This thesis presents the first use, or the application under new conditions, of three technologies that could contribute to optimization of mechanical ventilation.

    Optoelectronic plethysmography was used in Papers I and II for continuous assessment of changes in chest wall volume, configuration, and motion in the perioperative period. A forced oscillation technique (FOT) was used in Paper III to evaluate a novel positive end-expiratory pressure (PEEP) optimization strategy. Finally, in Paper IV, FOT in conjunction with an optical sensor based on a self-mixing laser interferometer (LIR) was used to study the oscillatory mechanics of the respiratory system and to measure the chest wall displacement.

    In Paper I, propofol anesthesia decreased end-expiratory chest wall volume (VeeCW) during induction, with a more pronounced effect on the abdominal compartment than on the rib cage. The main novel findings were an increased relative contribution of the rib cage to ventilation after induction of anesthesia, and the fact that the rib cage initiates post-apneic ventilation. In Paper II, a combination of recruitment maneuvers, PEEP, and reduced fraction of inspired oxygen, was found to preserve lung volume during and after anesthesia. Furthermore, the decrease in VeeCW during emergence from anesthesia, associated with activation of the expiratory muscles, suggested that active expiration may contribute to decreased functional residual capacity, during emergence from anesthesia.

    In the lavage model of lung injury studied in Paper III, a PEEP optimization strategy based on maximizing oscillatory reactance measured by FOT resulted in improved lung mechanics, increased oxygenation, and reduced histopathologic evidence of ventilator-induced lung injury.

    Paper IV showed that it is possible to apply both FOT and LIR simultaneously in various conditions ranging from awake quiet breathing to general anesthesia with controlled mechanical ventilation. In the case of LIR, an impedance map representing different regions of the chest wall showed reproducible changes during the different stages that suggested a high sensitivity of the LIR-based measurements.

    Delarbeten
    1. Effects of propofol anaesthesia on thoraco-abdominal volume variations during spontaneous breathing and mechanical ventilation
    Öppna denna publikation i ny flik eller fönster >>Effects of propofol anaesthesia on thoraco-abdominal volume variations during spontaneous breathing and mechanical ventilation
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    2011 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, nr 5, s. 588-596Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background Anaesthesia based on inhalational agents has profound effects on chest wall configuration and breathing pattern. The effects of propofol are less well characterised. The aim of the current study was to evaluate the effects of propofol anaesthesia on chest wall motion during spontaneous breathing and positive pressure ventilation. Methods We studied 16 subjects undergoing elective surgery requiring general anaesthesia. Chest wall volumes were continuously monitored by opto-electronic plethysmography during quiet breathing (QB) in the conscious state, induction of anaesthesia, spontaneous breathing during anaesthesia (SB), pressure support ventilation (PSV) and pressure control ventilation (PCV) after muscle paralysis. Results The total chest wall volume decreased by 0.41 +/- 0.08 l immediately after induction by equal reductions in the rib cage and abdominal volumes. An increase in the rib cage volume was then seen, resulting in total chest wall volumes 0.26 +/- 0.09, 0.24 +/- 0.10, 0.22 +/- 0.10 l lower than baseline, during SB, PSV and PCV, respectively. During QB, rib cage volume displacement corresponded to 34.2 +/- 5.3% of the tidal volume. During SB, PSV and PCV, this increased to 42.2 +/- 4.9%, 48.2 +/- 3.6% and 46.3 +/- 3.2%, respectively, with a corresponding decrease in the abdominal contribution. Breathing was initiated by the rib cage muscles during SB. Conclusion Propofol anaesthesia decreases end-expiratory chest wall volume, with a more pronounced effect on the diaphragm than on the rib cage muscles, which initiate breathing after apnoea.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-152944 (URN)10.1111/j.1399-6576.2011.02413.x (DOI)000289365000014 ()
    Tillgänglig från: 2011-05-03 Skapad: 2011-05-03 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
    2. Active expiration may contribute to the reduction in end-expiratory volume during emergence from anesthesia and in the immediate post-operative period.
    Öppna denna publikation i ny flik eller fönster >>Active expiration may contribute to the reduction in end-expiratory volume during emergence from anesthesia and in the immediate post-operative period.
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Anestesiologi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-248627 (URN)
    Tillgänglig från: 2015-04-05 Skapad: 2015-04-05 Senast uppdaterad: 2015-07-07
    3. Positive end-expiratory pressure optimization with forced oscillation technique reduces ventilator induced lung injury: a controlled experimental study in pigs with saline lavage lung injury
    Öppna denna publikation i ny flik eller fönster >>Positive end-expiratory pressure optimization with forced oscillation technique reduces ventilator induced lung injury: a controlled experimental study in pigs with saline lavage lung injury
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    2011 (Engelska)Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 15, nr 3, s. R126-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction: Protocols using high levels of positive end-expiratory pressure (PEEP) in combination with low tidal volumes have been shown to reduce mortality in patients with severe acute respiratory distress syndrome (ARDS). However, the optimal method for setting PEEP is yet to be defined. It has been shown that respiratory system reactance (Xrs), measured by the forced oscillation technique (FOT) at 5 Hz, may be used to identify the minimal PEEP level required to maintain lung recruitment. The aim of the present study was to evaluate if using Xrs for setting PEEP would improve lung mechanics and reduce lung injury compared to an oxygenation-based approach.

    Methods: 17 pigs, in which acute lung injury (ALI) was induced by saline lavage, were studied. Animals were randomized into two groups: in the first PEEP was titrated according to Xrs (FOT group), in the control group PEEP was set according to the ARDSNet protocol (ARDSNet group). The duration of the trial was 12 hours. In both groups recruitment maneuvers (RM) were performed every 2 hours, increasing PEEP to 20 cmH(2)O. In the FOT group PEEP was titrated by monitoring Xrs while PEEP was reduced from 20 cmH(2)O in steps of 2 cmH(2)O. PEEP was considered optimal at the step before which Xrs started to decrease. Ventilatory parameters, lung mechanics, blood gases and hemodynamic parameters were recorded hourly. Lung injury was evaluated by histopathological analysis.

    Results: The PEEP levels set in the FOT group were significantly higher compared to those set in the ARDSNet group during the whole trial. These higher values of PEEP resulted in improved lung mechanics, reduced driving pressure, improved oxygenation, with a trend for higher PaCO(2) and lower systemic and pulmonary pressure. After 12 hours of ventilation, histopathological analysis showed a significantly lower score of lung injury in the FOT group compared to the ARDSNet group.

    Conclusions: In a lavage model of lung injury a PEEP optimization strategy based on maximizing Xrs attenuated the signs of ventilator induced lung injury. The respiratory system reactance measured by FOT could thus be an important component in a strategy for delivering protective ventilation to patients with ARDS/acute lung injury.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-162094 (URN)10.1186/cc10236 (DOI)000295799700008 ()
    Tillgänglig från: 2011-11-24 Skapad: 2011-11-24 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
    4. The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation.
    Öppna denna publikation i ny flik eller fönster >>The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation.
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Anestesiologi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-248628 (URN)
    Tillgänglig från: 2015-04-05 Skapad: 2015-04-05 Senast uppdaterad: 2015-07-07
  • 183.
    Kostic, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lo Mauro, Antonella
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Pedotti, Antonio
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Frykholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Aliverti, Andrea
    Active expiration may contribute to the reduction in end-expiratory volume during emergence from anesthesia and in the immediate post-operative period.Manuskript (preprint) (Övrigt vetenskapligt)
  • 184.
    Kostic, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Milesi, Ilaria
    Zannin, Emanuela
    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.
    Frykholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Dellaca, Raffaele L
    The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation.Manuskript (preprint) (Övrigt vetenskapligt)
  • 185.
    Krakau, Karolina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Energy Balance out of Balance after Severe Traumatic Brain Injury2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of the research presented here was to expand the knowledge on metabolic course and nutritional outcome in patients with severe traumatic brain injury and to analyze the use and accuracy of different methods of assessment.

    Study I, a systematic review of 30 articles demonstrated consistent data on increased metabolic rate, of catabolism and of upper gastrointestinal intolerance in the majority of the patients during early post injury period. Data also indicated a tendency of less morbidity and mortality in early fed patients.

    Study II, a retrospective survey, based on medical records of 64 patients from three regions in Sweden, showed that the majority of patients regained their independence in eating within six months post injury. However, energy intake was set at a low level and 68 % of the patients developed malnutrition with 10 to 29 % loss of initial body mass during the first and second month post injury.

    Study III, a questionnaire based study addressed to 74 care units caring for patients with severe traumatic brain injury showed that resources in terms of qualified staff members were reportedly good, but nutritional guidelines were adopted in less than half of the units, screening for malnutrition at admission was rarely performed and surveillance of energy intake declined when oral intake began. Moreover, assessment of energy requirements relied on calculations and the profession in charge to estimate energy requirement varied depending on nutritional route and unit speciality. At transferral between units nutritional information was lost.

    Study IV and V, a prospective descriptive study on metabolic course, energy balance and methods of assessment in six patients showed that patients were in negative energy balance from 3rd week post injury and lost 8-19 % of their initial body weight. Concurrent nutritional problems were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was considered satisfactory. The majority of methods for predicting energy expenditure agreed poorly with measured energy expenditure.  The Penn-State equation from 1998 was the only valid predictive method during mechanical ventilation.

    This thesis concludes that patients with moderate or severe traumatic brain injury exhibit a wide range of increased metabolic rate, catabolism and upper gastrointestinal intolerance during the early post-injury period. Most patients regain independence in eating, but develop malnutrition. Suggested explanations, other than the systemic disturbances early post injury, could be the use of inaccurate predictions of energy expenditure, deficient nutritional routines and difficulties in securing alternative nutritional routes until oral feeding is satisfactory. The impact of timing, content and ways of administration of nutritional support on neurological outcome after a severe traumatic brain injury remains to be demonstrated.

    Delarbeten
    1. Metabolism and nutrition in patients with moderate and severe traumatic brain injury: A systematic review
    Öppna denna publikation i ny flik eller fönster >>Metabolism and nutrition in patients with moderate and severe traumatic brain injury: A systematic review
    2006 (Engelska)Ingår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 20, nr 4, s. 345-67Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    PRIMARY OBJECTIVE: To examine the evidence on the metabolic state and nutritional treatment of patients with moderate-to-severe traumatic brain injury (TBI). Research design: A systematic review of the literature. METHODS AND PROCEDURES: From 1547 citations, 232 articles were identified and retrieved for text screening. Thirty-six studies fulfilled the criteria and 30 were accepted for data extraction. MAIN OUTCOMES AND RESULTS: Variations in measurement methods and definitions of metabolic abnormalities hampered comparison of studies. However, consistent data demonstrated increased metabolic rate (96-160% of the predicted values), of hypercatabolism (-3 to -16 g N per day) and of upper gastrointestinal intolerance in the majority of the patients during the first 2 weeks after injury. Data also indicated a tendency towards less morbidity and mortality in early fed patients. CONCLUSIONS: The impact of timing, content and ways of administration of nutritional support on neurological outcome after TBI remains to be demonstrated.

    Nyckelord
    Traumatic brain injury, hypermetabolism, catabolism, gastrointestinal dysfunction, nutritional support
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-81685 (URN)10.1080/02699050500487571 (DOI)16716982 (PubMedID)
    Tillgänglig från: 2008-06-29 Skapad: 2008-06-29 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    2. Nutritional treatment of patients with severe traumatic brain injury during the first six months after injury
    Öppna denna publikation i ny flik eller fönster >>Nutritional treatment of patients with severe traumatic brain injury during the first six months after injury
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    2007 (Engelska)Ingår i: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 23, nr 4, s. 308-317Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: This study explored current nutritional treatment policies and nutritional outcome in patients with severe traumatic brain injury. Methods: We performed a retrospective, structured survey of the medical records of 64 patients up to 6 months after injury or until the patients were independent in nutritional administration. Results: Enteral nutrition was administered to 86% of patients. Fourteen patients (22%) had a gastrostomy; after 6 months four were still in use. At 6 months, 92% of patients received all food orally and 84% had gained nutritional independence. Energy intake was equal to the calculated basal metabolic rate throughout the first month after injury and increased by 21% during the second month. Sixty-eight percent exhibited signs of malnourishment with weight losses of 10-29%. Conclusion: This study suggests that most patients with severe traumatic brain injury regain their nutritional independence within the first 6 months after injury, but also that most develop signs of malnutrition.

    Nyckelord
    Traumatic brain injury, Parenteral nutrition, Enteral nutrition, Oral feeding, Level of independence, Malnutrition
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-10739 (URN)10.1016/j.nut.2007.01.010 (DOI)000245848800005 ()17369022 (PubMedID)
    Tillgänglig från: 2007-04-23 Skapad: 2007-04-23 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
    3. Resources and routines for nutritional assessment of patients with severe traumatic brain injury
    Öppna denna publikation i ny flik eller fönster >>Resources and routines for nutritional assessment of patients with severe traumatic brain injury
    Visa övriga...
    2010 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 1, s. 3-13Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: To describe the resources and routines for nutritional management until 6 months after severe traumatic brain injury. Methods: Data collection was performed by use of questionnaires to staff professionals at three regional neurosurgical intensive and 75 other care units and a retrospective survey of medical and nursing records from 64 patients treated at these units. Results: Resources in terms of qualified staff members were reportedly good, while nutritional guidelines were adopted in less than half of the units. Screening for malnutrition at admission was rarely performed and the nutritional data in medical and nursing records were incomplete, i.e. there was a lack of body weight measurements in more than one-third of the care unit episodes and of body height data in more than half of the patients and a declining surveillance of energy intake when patients changed from parenteral or enteral nutrition to oral intake. Assessment of energy requirements relied on calculations and the assignment of who was to estimate it varied depending on which nutritional route was used and also between unit specialities. Finally, information on energy requirement, weight development and body mass index was present in only 16%, 7% and in 2% of the transferrals. Conclusions: Despite good resources of qualified staff, the nutritional assessment routines were deficient, resulting in incomplete nutritional data and lost nutritional information.

    Nyckelord
    Nutrition, Head injury, Nutritional assessment, Critical care, Questionnaires, Quantitative approaches
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Nutrition
    Identifikatorer
    urn:nbn:se:uu:diva-114115 (URN)10.1111/j.1471-6712.2008.00677.x (DOI)000274389900002 ()19497027 (PubMedID)
    Tillgänglig från: 2010-02-10 Skapad: 2010-02-10 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    4. Energy balance and metabolism after severe traumatic brain injury: A pilot study using doubly labelled water
    Öppna denna publikation i ny flik eller fönster >>Energy balance and metabolism after severe traumatic brain injury: A pilot study using doubly labelled water
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To explore the course of energy balance in patients with severe traumatic brain injury, from time of injury until twelve weeks post injury.

    Method: This prospective desriptive study included six patients with isolated, closed severe traumatic brain injury and an expected hospital stay of ≥2-3 months. Energy balance was calculated from energy intake compared to total energy expenditure measured by continuous indirect calorimetry and doubly labelled water. Clinical and laboratory variables with possible influence on metabolism and nutritional delivery were recorded simultaneously. Intermittent indirect calorimetry measurements were used to differentiate components of the energy expended.

    Results: Patients were roughly in energy balance while on mechanical ventilation, but in negative energy balance from the 3rd week post injury. The total energy expenditure then increased while the daily energy intake declined. Concurrent with this period were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was satisfactory. Nitrogen balance was back to normal at about 1.5 months and the inflammatory period with increased C-reactive protein levels continued for 12 to 58 days from time of injury. During the first and second month post injury, patients lost 8-19% of their initial body weight.

    Conclusion: Data suggests that negative energy balance after a severe TBI could not only be explained by the elevated metabolic rate and catabolism induced by the trauma, but also by difficulties in securing alternative nutritional routes in the distressed patient.

    Nyckelord
    Enegy balance, Metabolism, Traumatic brain injury, Doubly labelled water, Indirect calorimetry, Energy intake
    Nationell ämneskategori
    Näringslära Anestesi och intensivvård Kirurgi Omvårdnad
    Forskningsämne
    Nutrition; Omvårdnadsforskning med medicinsk inriktning; Rehabiliteringsmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-114122 (URN)
    Tillgänglig från: 2010-02-10 Skapad: 2010-02-10 Senast uppdaterad: 2010-02-10
    5. Prediction of energy expenditure in patients with severe traumatic brain injury: A validation study by use of continuous indirect calorimetry and doubly labelled water
    Öppna denna publikation i ny flik eller fönster >>Prediction of energy expenditure in patients with severe traumatic brain injury: A validation study by use of continuous indirect calorimetry and doubly labelled water
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: The aim was to evaluate the accuracy of methods to predict energy expenditure (EE) in patients with severe traumatic brain injury (TBI).

    Method: To this prospective descriptive study, a small cohort of patients (n6) with isolated, severe TBI and an expected hospital stay of ≥2-3 months were included. The EE was measured at two intervals: by continuous indirect calorimetry during mechanical ventilation and by doubly labelled water from 3rd to 5th week post injury. Different equations for prediction of EE and a portable monitor, the SenseWear Armband were compared to the measured EE.

    Result: The majority of methods for predicting EE agreed poorly with the measured EE during indirect calorimetry period. A good agreement was found only with the three Penn-State equations, but two were biased according to Bland Altman analysis. The Penn-State equation from 1998 was the only valid predictive method, with a mean difference per day close to zero (+22 kcal), an excellent agreement (ICC 0.82) with 72% (n54/75) accurately assessed days (±10% of the measured EE) and with all patients within clinically acceptable levels, i.e. ±15% of the measured EE. During doubly labelled water period, observations were too few for any conclusive statement.

    Conclusion: These data support use of the Penn-State equation from 1998 to estimate EE in patients with severe TBI while on mechanical ventilation.

    Nyckelord
    Predicted energy expenditure, SenseWear Armband, Indirect calorimetry, Doubly labelled water, Traumatic brain injury
    Nationell ämneskategori
    Näringslära Anestesi och intensivvård Kirurgi Omvårdnad
    Forskningsämne
    Anestesiologi och intensivvård; Nutrition; Omvårdnadsforskning med medicinsk inriktning
    Identifikatorer
    urn:nbn:se:uu:diva-114123 (URN)
    Tillgänglig från: 2010-02-10 Skapad: 2010-02-10 Senast uppdaterad: 2010-02-10
  • 186.
    Krakau, Karolina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Ellegård, Lars
    Department of Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital, Gothenburg.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska University Hospital Solna, Stockholm.
    Karlsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nygren de Boussard, Catharina
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Borg, Jörgen
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Prediction of energy expenditure in patients with severe traumatic brain injury: A validation study by use of continuous indirect calorimetry and doubly labelled waterManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: The aim was to evaluate the accuracy of methods to predict energy expenditure (EE) in patients with severe traumatic brain injury (TBI).

    Method: To this prospective descriptive study, a small cohort of patients (n6) with isolated, severe TBI and an expected hospital stay of ≥2-3 months were included. The EE was measured at two intervals: by continuous indirect calorimetry during mechanical ventilation and by doubly labelled water from 3rd to 5th week post injury. Different equations for prediction of EE and a portable monitor, the SenseWear Armband were compared to the measured EE.

    Result: The majority of methods for predicting EE agreed poorly with the measured EE during indirect calorimetry period. A good agreement was found only with the three Penn-State equations, but two were biased according to Bland Altman analysis. The Penn-State equation from 1998 was the only valid predictive method, with a mean difference per day close to zero (+22 kcal), an excellent agreement (ICC 0.82) with 72% (n54/75) accurately assessed days (±10% of the measured EE) and with all patients within clinically acceptable levels, i.e. ±15% of the measured EE. During doubly labelled water period, observations were too few for any conclusive statement.

    Conclusion: These data support use of the Penn-State equation from 1998 to estimate EE in patients with severe TBI while on mechanical ventilation.

  • 187.
    Krakau, Karolina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Ellegård, Lars
    Department of Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital, Gothenburg.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska University Hospital Solna, Stockholm.
    Karlsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nygren de Boussard, Catharina
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Karlsson, Michael
    Danderyd Geriatric Center, Danderyd University Hospital, Stockholm.
    Borg, Jörgen
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Energy balance and metabolism after severe traumatic brain injury: A pilot study using doubly labelled waterManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To explore the course of energy balance in patients with severe traumatic brain injury, from time of injury until twelve weeks post injury.

    Method: This prospective desriptive study included six patients with isolated, closed severe traumatic brain injury and an expected hospital stay of ≥2-3 months. Energy balance was calculated from energy intake compared to total energy expenditure measured by continuous indirect calorimetry and doubly labelled water. Clinical and laboratory variables with possible influence on metabolism and nutritional delivery were recorded simultaneously. Intermittent indirect calorimetry measurements were used to differentiate components of the energy expended.

    Results: Patients were roughly in energy balance while on mechanical ventilation, but in negative energy balance from the 3rd week post injury. The total energy expenditure then increased while the daily energy intake declined. Concurrent with this period were difficulties in retaining enteral and/or parenteral nutrition delivery routes until oral feeding was satisfactory. Nitrogen balance was back to normal at about 1.5 months and the inflammatory period with increased C-reactive protein levels continued for 12 to 58 days from time of injury. During the first and second month post injury, patients lost 8-19% of their initial body weight.

    Conclusion: Data suggests that negative energy balance after a severe TBI could not only be explained by the elevated metabolic rate and catabolism induced by the trauma, but also by difficulties in securing alternative nutritional routes in the distressed patient.

  • 188.
    Kretzschmar, Moritz A.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Univ Magdeburg, Dept Anaesthesiol & Intens Care Med, Leipziger Str 44, D-39120 Magdeburg, Germany..
    Hachenberg, Thomas
    Univ Magdeburg, Dept Anaesthesiol & Intens Care Med, Leipziger Str 44, D-39120 Magdeburg, Germany..
    Thoracic anaesthesia 20162016Ingår i: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 29, nr 1, s. 1-1Artikel i tidskrift (Övrigt vetenskapligt)
  • 189.
    Kretzschmar, Moritz A.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hachenberg, Thomas
    Thoracic anesthesia2015Ingår i: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 28, nr 1, s. 1-1Artikel i tidskrift (Övrigt vetenskapligt)
  • 190.
    Kretzschmar, Moritz Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Ventilation/Perfusion Matching and its Effect on Volatile Pharmacokinetics2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The mismatching of alveolar ventilation and perfusion (VA/Q) is the major determinant of impaired gas exchange. The gold standard for analyzing VA/Q distribution is the multiple inert gas elimination technique (MIGET), conventionally based on gas chromatography (GC), and, although simple in principle, a technically demanding procedure limiting its use. A new technique based on micropore membrane inlet mass spectrometry (MMIMS) combined MIGET with mass spectrometry, simplifying the sample handling process, and potentially providing VA/Q distributions for a general clinical approach.

    The kinetics of volatile anesthetics are well known in patients with healthy lungs. The uptake and distribution of inhaled anesthetics have usually been modeled by physiologic models. However, these models have limitations, and they do not consider ventilation/perfusion matching. Respiratory diseases account for a large part of morbidity and mortality and are associated with pulmonary VA/Q mismatch that may affect uptake and elimination of volatile anesthetics.

    The objectives of the studies were firstly to investigate assessment of VA/Q mismatch by MMIMS and secondly to investigate the effects of asthma-like VA/Q mismatch on the kinetics of volatile anesthetics in an experimental porcine model.

    Anesthetized and mechanically ventilated piglets were studied.

    In study I, a direct comparison of MIGET by MMIMS with the conventional MIGET by GC in three animal models that covered a wide range of VA/Q distributions was preformed. The two methods agreed well, and parameters derived from both methods showed good agreement with externally measured references.

    In studies II–IV, a stable method of inducing and maintaining asthma-like VA/Q mismatch with methacholine (MCh) administration was established, and the effect of VA/Q mismatch on the pharmacokinetics of desflurane and isoflurane was investigated. The present model of bronchoconstriction demonstrates a delay in volatile anesthetic uptake and elimination, related to the heterogeneity of MCh-inhalation induced ventilation. The difference in solubility of volatile anesthetics has a significant influence on their uptake and elimination under VA/Q mismatch. The higher blood soluble isoflurane is affected to a lesser degree than the fairly insoluble desflurane.

    Delarbeten
    1. Multiple inert gas elimination technique by micropore membrane inlet mass spectrometry-a comparison with reference gas chromatography
    Öppna denna publikation i ny flik eller fönster >>Multiple inert gas elimination technique by micropore membrane inlet mass spectrometry-a comparison with reference gas chromatography
    Visa övriga...
    2013 (Engelska)Ingår i: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 115, nr 8, s. 1107-1118Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The mismatching of alveolar ventilation and perfusion (V-A/Q) is the major determinant of impaired gas exchange. The gold standard for measuring V-A/Q distributions is based on measurements of the elimination and retention of infused inert gases. Conventional multiple inert gas elimination technique (MIGET) uses gas chromatography (GC) to measure the inert gas partial pressures, which requires tonometry of blood samples with a gas that can then be injected into the chromatograph. The method is laborious and requires meticulous care. A new technique based on micropore membrane inlet mass spectrometry (MMIMS) facilitates the handling of blood and gas samples and provides nearly real-time analysis. In this study we compared MIGET by GC and MMIMS in 10 piglets: 1) 3 with healthy lungs; 2) 4 with oleic acid injury; and 3) 3 with isolated left lower lobe ventilation. The different protocols ensured a large range of normal and abnormal V-A/Q distributions. Eight inert gases (SF6, krypton, ethane, cyclopropane, desflurane, enflurane, diethyl ether, and acetone) were infused; six of these gases were measured with MMIMS, and six were measured with GC. We found close agreement of retention and excretion of the gases and the constructed V-A/Q distributions between GC and MMIMS, and predicted Pa-O2 from both methods compared well with measured Pa-O2. V-A/Q by GC produced more widely dispersed modes than MMIMS, explained in part by differences in the algorithms used to calculate V-A/Q distributions. In conclusion, MMIMS enables faster measurement of V-A/Q, is less demanding than GC, and produces comparable results.

    Nyckelord
    MIGET, ventilation/perfusion distributions, inert gases, mass spectrometry, membrane inlet, gas chromatography
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-210589 (URN)10.1152/japplphysiol.00072.2013 (DOI)000325869400001 ()
    Tillgänglig från: 2013-11-11 Skapad: 2013-11-11 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
    2. Effects of methacholine infusion on desflurane pharmacokinetics in piglets
    Öppna denna publikation i ny flik eller fönster >>Effects of methacholine infusion on desflurane pharmacokinetics in piglets
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    2015 (Engelska)Ingår i: Data in brief, ISSN 2352-3409, Vol. 5, s. 939-947Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The data of a corresponding animal experiment demonstrates that nebulized methacholine (MCh) induced severe bronchoconstriction and significant inhomogeneous ventilation and pulmonary perfusion (V̇A/Q̇) distribution in pigs, which is similar to findings in human asthma. The inhalation of MCh induced bronchoconstriction and delayed both uptake and elimination of desflurane (Kretzschmar et al., 2015) [1]. The objective of the present data is to determine V̇A/Q̇ matching by Multiple Inert Gas Elimination Technique (MIGET) in piglets before and during methacholine- (MCh-) induced bronchoconstriction, induced by MCh infusion, and to assess the blood concentration profiles for desflurane (DES) by Micropore Membrane Inlet Mass Spectrometry (MMIMS). Healthy piglets (n=4) under general anesthesia were instrumented with arterial, central venous, and pulmonary artery lines. The airway was secured via median tracheostomy with an endotracheal tube, and animals were mechanically ventilated with intermittent positive pressure ventilation (IPPV) with a FiO2 of 0.4, tidal volume (V T)=10 ml/kg and PEEP of 5cmH2O using an open system. The determination of V.A/Q. was done by MIGET: before desflurane application and at plateau in both healthy state and during MCh infusion. Arterial blood was sampled at 0, 1, 2, 5, 10, 20, and 30 min during wash-in and washout, respectively. Bronchoconstriction was established by MCH infusion aiming at doubling the peak airway pressure, after which wash-in and washout of the anesthetic gas was repeated. Anesthesia gas concentrations were measured by MMIMS. Data were analyzed by ANOVA, paired t-test, and by nonparametric Friedman׳s test and Wilcoxon׳s matched pairs test. We measured airway pressures, pulmonary resistance, and mean paO2 as well as hemodynamic variables in all pigs before desflurane application and at plateau in both healthy state and during methacholine administration by infusion. By MIGET, fractional alveolar ventilation and pulmonary perfusion in relation to the V.A/Q. compartments, data of logSDQ̇ and logSDV̇ (the second moments describing global dispersion, i.e. heterogeneity of distribution) were estimated prior to and after MCh infusion. The uptake and elimination of desflurane was determined by MMIMS.

    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:uu:diva-275036 (URN)10.1016/j.dib.2015.11.002 (DOI)26702425 (PubMedID)
    Anmärkning

    Alf Kozian, Moritz Kretzschmar and Thomas Schilling were equally involved in processing the experiments, in analyzing the data, and in preparing of themanuscript.

    Tillgänglig från: 2016-01-28 Skapad: 2016-01-28 Senast uppdaterad: 2016-12-08Bibliografiskt granskad
    3. Bronchoconstriction induced by inhaled methacholine delays desflurane uptake and elimination in a piglet model
    Öppna denna publikation i ny flik eller fönster >>Bronchoconstriction induced by inhaled methacholine delays desflurane uptake and elimination in a piglet model
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    2016 (Engelska)Ingår i: Respiratory Physiology & Neurobiology, ISSN 1569-9048, E-ISSN 1878-1519, Vol. 220, s. 88-94Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Bronchoconstriction is a hallmark of asthma and impairs gas exchange. We hypothesized that pharmacokinetics of volatile anesthetics would be affected by bronchoconstriction. Ventilation/perfusion (V̇A/Q̇) ratios and pharmacokinetics of desflurane in both healthy state and during inhalational administration of methacholine (MCh) to double peak airway pressure were studied in a piglet model. In piglets, MCh administration by inhalation (100μg/ml, n=6) increased respiratory resistance, impaired V̇A/Q̇ distribution, increased shunt, and decreased paO2 in all animals. The uptake and elimination of desflurane in arterial blood was delayed by nebulization of MCh, as determined by Micropore Membrane Inlet Mass Spectrometry (wash-in time to P50, healthy vs. inhalation: 0.5min vs. 1.1min, to P90: 4.0min vs. 14.8min). Volatile elimination was accordingly delayed. Inhaled methacholine induced severe bronchoconstriction and marked inhomogeneous V̇A/Q̇ distribution in pigs, which is similar to findings in human asthma exacerbation. Furthermore, MCh-induced bronchoconstriction delayed both uptake and elimination of desflurane. These findings might be considered when administering inhalational anesthesia to asthmatic patients.

    Nationell ämneskategori
    Fysiologi Lungmedicin och allergi Medicin och hälsovetenskap
    Forskningsämne
    Fysiologi
    Identifikatorer
    urn:nbn:se:uu:diva-264207 (URN)10.1016/j.resp.2015.09.014 (DOI)000368045500012 ()26440992 (PubMedID)
    Forskningsfinansiär
    Vetenskapsrådet, 5315 X2015-99x-22731-01-04Hjärt-Lungfonden
    Tillgänglig från: 2015-10-07 Skapad: 2015-10-07 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    4. Effect of Bronchoconstriction-induced Ventilation-Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane
    Öppna denna publikation i ny flik eller fönster >>Effect of Bronchoconstriction-induced Ventilation-Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane
    Visa övriga...
    2017 (Engelska)Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 127, nr 5, s. 800-812Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been examined. Volatile anesthetics with higher blood solubility would be less affected by VA/Q mismatch. We therefore compared uptake and elimination of higher soluble isoflurane and less soluble desflurane in a piglet model.

    METHODS: Juvenile piglets (26.7 ± 1.5 kg) received either isoflurane (n = 7) or desflurane (n = 7). Arterial and mixed venous blood samples were obtained during wash-in and wash-out of volatile anesthetics before and during bronchoconstriction by methacholine inhalation (100 μg/ml). Total uptake and elimination were calculated based on partial pressure measurements by micropore membrane inlet mass spectrometry and literature-derived partition coefficients and assumed end-expired to arterial gradients to be negligible. VA/Q distribution was assessed by the multiple inert gas elimination technique.

    RESULTS: Before methacholine inhalation, isoflurane arterial partial pressures reached 90% of final plateau within 16 min and decreased to 10% after 28 min. By methacholine nebulization, arterial uptake and elimination delayed to 35 and 44 min. Desflurane needed 4 min during wash-in and 6 min during wash-out, but with bronchoconstriction 90% of both uptake and elimination was reached within 15 min.

    CONCLUSIONS: Inhaled methacholine induced bronchoconstriction and inhomogeneous VA/Q distribution. Solubility of inhalational anesthetics significantly influenced pharmacokinetics: higher soluble isoflurane is less affected than fairly insoluble desflurane, indicating different uptake and elimination during bronchoconstriction.

    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-334179 (URN)10.1097/ALN.0000000000001847 (DOI)000414634700010 ()28857808 (PubMedID)
    Forskningsfinansiär
    Vetenskapsrådet, X2015-99x-22731-01-04
    Tillgänglig från: 2017-11-21 Skapad: 2017-11-21 Senast uppdaterad: 2018-02-16Bibliografiskt granskad
  • 191.
    Kretzschmar, Moritz
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Kozian, Alf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Baumgardner, James E
    Oscill LLC, Pittsburgh, PA USA; Univ Pittsburgh, Med Ctr, Dept Anesthesiol, Pittsburgh, PA USA.
    Borges, João Batista
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hachenberg, Thomas
    Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Schilling, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Effect of Bronchoconstriction-induced Ventilation-Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane2017Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 127, nr 5, s. 800-812Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been examined. Volatile anesthetics with higher blood solubility would be less affected by VA/Q mismatch. We therefore compared uptake and elimination of higher soluble isoflurane and less soluble desflurane in a piglet model.

    METHODS: Juvenile piglets (26.7 ± 1.5 kg) received either isoflurane (n = 7) or desflurane (n = 7). Arterial and mixed venous blood samples were obtained during wash-in and wash-out of volatile anesthetics before and during bronchoconstriction by methacholine inhalation (100 μg/ml). Total uptake and elimination were calculated based on partial pressure measurements by micropore membrane inlet mass spectrometry and literature-derived partition coefficients and assumed end-expired to arterial gradients to be negligible. VA/Q distribution was assessed by the multiple inert gas elimination technique.

    RESULTS: Before methacholine inhalation, isoflurane arterial partial pressures reached 90% of final plateau within 16 min and decreased to 10% after 28 min. By methacholine nebulization, arterial uptake and elimination delayed to 35 and 44 min. Desflurane needed 4 min during wash-in and 6 min during wash-out, but with bronchoconstriction 90% of both uptake and elimination was reached within 15 min.

    CONCLUSIONS: Inhaled methacholine induced bronchoconstriction and inhomogeneous VA/Q distribution. Solubility of inhalational anesthetics significantly influenced pharmacokinetics: higher soluble isoflurane is less affected than fairly insoluble desflurane, indicating different uptake and elimination during bronchoconstriction.

  • 192.
    Kvarnström, Ann
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Neuropathic Pain; Quality of Life, Sensory Assessments and Pharmacological Treatments2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Neuropathic pain of central and peripheral origin presents a substantial clinical problem as it is often resistant to pharmacological treatment.

    The health related quality of life of 126 patients with peripheral neuropathic pain was studied, to provide a cross sectional description from this point of view. Two generic health-related quality of life instruments; the SF-36 and the Nottingham Health Profile were used together with pain assessments, global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors.

    The analgesic effect of ketamine, lidocaine and morphine were assessed in a double blind, placebo-controlled, randomized study design. Three groups of patients were studied: patients with peripheral neuropathic pain of traumatic origin, patients with central post-stroke pain and patients with neuropathic pain after spinal cord injury. Somatosensory function was examined to see if this could predict response to treatment and to investigate if the drugs caused changes in thermal or mechanical sensibility.

    The results shows that the intense pain, limited efficacy and tolerability of available treatments, the low overall rating of health, reduced work status and troublesome symptoms constitute a substantial impact on the quality of life for patients with peripheral neuropathic pain.

    The NMDA-antagonist ketamine yielded substantial pain relief to patients with peripheral neuropathic pain and patients with neuropathic pain after spinal cord injury. However, the reported side effects limit the clinical usefulness of the treatment. Lidocaine did not give significant pain relief to the patients in the three studied groups. Morphine may represent a therapeutic alternative for some patients with central post-stroke pain, although only a small group of this category of patients responded with analgesia.

    Assessment of baseline somatosensory functions could not be used to identify responders to treatment with either drug, nor did ketamine, lidocaine or morphine cause any changes in thermal or mechanical sensibility.

    Delarbeten
    1. Peripheral neuropathic pain- a multidimensional burden for patients
    Öppna denna publikation i ny flik eller fönster >>Peripheral neuropathic pain- a multidimensional burden for patients
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    2001 Ingår i: European Journal of Pain, Vol. 5, s. 379-389Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-91046 (URN)
    Tillgänglig från: 2003-11-19 Skapad: 2003-11-19Bibliografiskt granskad
    2. The effectiveness of intravenous ketamine and lidocaine on peripheral neuropathic pain
    Öppna denna publikation i ny flik eller fönster >>The effectiveness of intravenous ketamine and lidocaine on peripheral neuropathic pain
    Visa övriga...
    2003 Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 001-5172, Vol. 47, s. 868-877Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-91047 (URN)
    Tillgänglig från: 2003-11-19 Skapad: 2003-11-19Bibliografiskt granskad
    3. The analgesic effect of morphine and lidocaine on central post-stroke pain
    Öppna denna publikation i ny flik eller fönster >>The analgesic effect of morphine and lidocaine on central post-stroke pain
    Manuskript (Övrigt vetenskapligt)
    Identifikatorer
    urn:nbn:se:uu:diva-91048 (URN)
    Tillgänglig från: 2003-11-19 Skapad: 2003-11-19 Senast uppdaterad: 2010-01-13Bibliografiskt granskad
    4. The analgesic effect of intravenous ketamine and lidocaine on pain after spinal cord injury
    Öppna denna publikation i ny flik eller fönster >>The analgesic effect of intravenous ketamine and lidocaine on pain after spinal cord injury
    2004 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, nr 4, s. 498-506Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background:  Pain following spinal cord injury (SCI) is a therapeutic challenge. Only a few treatments have been assessed in randomized, controlled trials. The primary objective of the present study was to examine the analgesic effect of ketamine and lidocaine in a group of patients with neuropathic pain below the level of spinal cord injury. We also wanted to assess sensory abnormalities to see if this could help us to identify responders and if treatments resulted in changes of sensibility.

    Methods:  Ten patients with spinal cord injury and neuropathic pain below the level of injury were included. The analgesic effect of ketamine 0.4 mg kg−1 and lidocaine 2.5 mg kg−1 was investigated. Saline was used as placebo. The drugs were infused over 40 min. A randomized, double-blind, three-period, three-treatment, cross-over design was used. Systemic plasma concentrations of ketamine and lidocaine were assessed. Pain rating was performed using a visual analogue scale (VAS). Sensory function was assessed with a combination of traditional sensory tests and quantitative measurement of temperature thresholds.

    Results:  Response to treatment, defined as 50% reduction in VAS-score during infusion, was recorded in 5/10 in the ketamine, 1/10 in the lidocaine and 0/10 in the placebo groups. Neither ketamine nor lidocaine changed temperature thresholds or assessments of mechanical; dynamic and static sensibility. Nor could these sensory assessments predict response to treatment in this setting. Lidocaine and particularly ketamine were associated with frequent side-effects.

    Conclusion:  Ketamine but not lidocaine showed a significant analgesic effect in patients with neuropathic pain after spinal cord injury. The pain relief was not associated with altered temperature thresholds or other changes of sensory function.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91049 (URN)10.1111/j.1399-6576.2003.00330.x (DOI)15025615 (PubMedID)
    Tillgänglig från: 2003-11-19 Skapad: 2003-11-19 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
  • 193.
    Laake, J. H.
    et al.
    Oslo Univ Hosp, Div Crit Care & Emergencies, Dept Anaesthesiol, Oslo, Norway.
    Tonnessen, T. I.
    Oslo Univ Hosp, Div Crit Care & Emergencies, Dept Anaesthesiol, Oslo, Norway.
    Chew, M. S.
    Linkoping Univ, Dept Anaesthesia & Intens Care, Med & Hlth Sci, Linkoping, Sweden.
    Lipcsey, Miklós
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hjelmqvist, H.
    Orebro Univ, Sch Med Sci, Dept Anaesthesia & Intens Care, Orebro, Sweden;Univ Hosp, Orebro, Sweden.
    Wilkman, E.
    Univ Helsinki, Dept Anaesthesiol Intens Care & Pain Med, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Pettilae, V.
    Univ Helsinki, Dept Anaesthesiol Intens Care & Pain Med, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Hoffmann-Petersen, J.
    Odense Univ Hosp, Dept Anaesthesiol & Intens Care, Odense, Denmark.
    Moller, M. H.
    Copenhagen Univ Hosp, Rigshospi, Dept Intens Care, Copenhagen, Denmark.
    The SSAI fully supports the suspension of hydroxyethyl-starch solutions commissioned by the European Medicines Agency2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 6, s. 874-875Artikel i tidskrift (Övrigt vetenskapligt)
  • 194. Laffey, John G
    et al.
    Bellani, Giacomo
    Pham, Tài
    Fan, Eddy
    Madotto, Fabiana
    Bajwa, Ednan K
    Brochard, Laurent
    Clarkson, Kevin
    Esteban, Andres
    Gattinoni, Luciano
    van Haren, Frank
    Heunks, Leo M
    Kurahashi, Kiyoyasu
    Laake, Jon Henrik
    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.
    McAuley, Daniel F
    McNamee, Lia
    Nin, Nicolas
    Qiu, Haibo
    Ranieri, Marco
    Rubenfeld, Gordon D
    Thompson, B Taylor
    Wrigge, Hermann
    Slutsky, Arthur S
    Pesenti, Antonio
    Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study2016Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, nr 12, s. 1865-1876Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality.

    METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1-2 who received invasive mechanical ventilation.

    RESULTS: 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO2/FiO2 ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores.

    CONCLUSIONS: Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073.

  • 195. Lafuente, Jose Vicente
    et al.
    Sharma, Aruna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Patnaik, Ranjana
    Muresanu, Dafin Fior
    Sharma, Hari Shanker
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Diabetes Exacerbates Nanoparticles Induced Brain Pathology2012Ingår i: CNS & Neurological Disorders: Drug Targets, ISSN 1871-5273, E-ISSN 1996-3181, Vol. 11, nr 1, s. 26-39Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Long term exposure of nanoparticles e.g., silica dust (SiO2) from desert environments, or engineered nanoparticles from metals viz., Cu, Al or Ag from industry, ammunition, military equipment and related products may lead to adverse effects on mental health. However, it is unclear whether these nanoparticles may further adversely affect human health in cardiovascular or metabolic diseases e.g., hypertension or diabetes. It is quite likely that in diabetes or hypertension where the body immune system is already compromised there will be greater adverse effects following nanoparticles exposure on human health as compared to their exposure to healthy individuals. Previous experiments from our laboratory showed that diabetic or hypertensive animals are more susceptible to heat stress-induced neurotoxicity. Furthermore, traumatic injury to the spinal cord in SiO2 exposed rats resulted in exacerbation of cord pathology. However, whether nanoparticles such as Cu, Ag or SiO2 exposure will lead to enhanced neurotoxicity in diabetic animals are still not well investigated. Previous data from our laboratory showed that Cu or Ag intoxication (50 mg/kg, i.p. per day for 7 days) in streptozotocine induced diabetic rats exhibited enhanced neurotoxicity and exacerbation of sensory, motor and cognitive function as compared to normal animals under identical conditions. Thus the diabetic animals showed exacerbation of regional blood-brain barrier (BBB) disruption, edema formation and cell injuries along with greater reduction in the local cerebral blood flow (CBF) as compared to normal rats. These observations suggest that diabetic animals are more vulnerable to nanoparticles induced brain damage than healthy rats. The possible mechanisms and functional significance of these findings are discussed in this review largely based on our own investigations.

  • 196. Larsson, Anders
    et al.
    Barklin, A
    Theodorsson, E
    Tyvold, SS
    Garnfeldt, A
    Sloth, E
    Tonnesen, E
    Alteration of neuropeptides in the lung tissue correlates brain death-induced neurogenic edema2010Ingår i: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, E-ISSN 1557-3117, Vol. 54, s. 199-205Artikel i tidskrift (Refereegranskat)
  • 197.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Kjaergaard, B
    Kristensen, SR
    Risom, M
    A porcine model of massive, totally occlusive, pulmonary embolism2009Ingår i: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 124, s. 226-229Artikel i tidskrift (Refereegranskat)
  • 198.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Smekal, David
    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, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rapid testing of red blood cells, white blood cells and platelets in intensive care patients using the HemoScreen™ point-of-care analyzer2018Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, s. 1-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Acute major bleeding is a condition that can be encountered in critically ill patients and may require rapid transfusions. To evaluate the need for packed red blood cells (RBCs) and platelets (PLTs), it is important to have rapid test results for RBC/hemoglobin and PLTs. Recently, PixCell Medical (Yokneam Ilit, Israel) introduced the HemoScreen™, an automated hematology analyzer. It is a point-of-care device that uses single sample cuvettes and image analysis of RBCs, PLTs and white blood cells (WBCs), performing a five-part differential count. The HemoScreen™ is the first portable differential count instrument that uses image analysis. We compared the RBC, PLT, and WBC test results of the HemoScreen™ with the Sysmex XN device. In the study we analyzed 104 samples from the cardiothoracic, neuro and general intensive care units. The HemoScreen™ technique showed good precision, with total coefficient of variation of 1-2% for RBCs and 3-5% for PLTs. Deming correlations between the HemoScreen and the Sysmex XN instrument analyzer: (WBCHemoScreen™ = 1.061* WBCSysmex - 0.644; r = 0.995), RBC (RBCHemoScreen™ = 0.998* RBCSysmex + 0.049; r = 0.993) for WBC and (PlateletsHemoScreen™ = 1.087* PlateletsSysmex - 14.80; r = 0.994) for PLT. The HemoScreen™ device provided rapid and accurate test results to evaluate the need for RBC and PLT transfusion. This new technology is promising given that it allows the analysis of WBCs, RBCs, and PLTs further out in the healthcare organization compared with laboratory infrastructure based on traditional cell counters.

  • 199.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Vistisen, ST
    Struijk, JJ
    Automated pre-ejection period variation indexed to tidal volume predicts fluid responsiveness after cardiac surgery2009Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, s. 534-542Artikel i tidskrift (Refereegranskat)
  • 200.
    Larsson, Ing-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Post-Cardiac Arrest Care: Therapeutic Hypothermia, Patient Outcomes and Relatives’ Experiences2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay.

    In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice.

    The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome.

    In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL.

    In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence.

    In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.

    Delarbeten
    1. Cold saline infusion and ice packs alone are effective in inducing and maintaining therapeutic hypothermia after cardiac arrest
    Öppna denna publikation i ny flik eller fönster >>Cold saline infusion and ice packs alone are effective in inducing and maintaining therapeutic hypothermia after cardiac arrest
    2010 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, nr 1, s. 15-19Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM OF THE STUDY: Hypothermia treatment with cold intravenous infusion and ice packs after cardiac arrest has been described and used in clinical practice. We hypothesised that with this method a target temperature of 32-34 degrees C could be achieved and maintained during treatment and that rewarming could be controlled. MATERIALS AND METHODS: Thirty-eight patients treated with hypothermia after cardiac arrest were included in this prospective observational study. The patients were cooled with 4 degrees C intravenous saline infusion combined with ice packs applied in the groins, axillae, and along the neck. Hypothermia treatment was maintained for 26h after cardiac arrest. It was estimated that passive rewarming would occur over a period of 8h. Body temperature was monitored continuously and recorded every 15min up to 44h after cardiac arrest. RESULTS: All patients reached the target temperature interval of 32-34 degrees C within 279+/-185min from cardiac arrest and 216+/-177min from induction of cooling. In nine patients the temperature dropped to below 32 degrees C during a period of 15min up to 2.5h, with the lowest (nadir) temperature of 31.3 degrees C in one of the patients. The target temperature was maintained by periodically applying ice packs on the patients. Passive rewarming started 26h after cardiac arrest and continued for 8+/-3h. Rebound hyperthermia (>38 degrees C) occurred in eight patients 44h after cardiac arrest. CONCLUSIONS: Intravenous cold saline infusion combined with ice packs is effective in inducing and maintaining therapeutic hypothermia, with good temperature control even during rewarming.

    Nyckelord
    Hypothermia, Cardiac arrest, Outcome, Resuscitation, Temperature
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-113244 (URN)10.1016/j.resuscitation.2009.09.012 (DOI)000274321300004 ()19853352 (PubMedID)
    Tillgänglig från: 2010-01-26 Skapad: 2010-01-26 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    2. Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome
    Öppna denna publikation i ny flik eller fönster >>Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome
    Visa övriga...
    2014 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 12, s. 1654-1661Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM OF THE STUDY: To investigate serum levels of glial fibrillary acidic protein (GFAP) for evaluation of neurological outcome in cardiac arrest (CA) patients and compare GFAP sensitivity and specificity to that of more studied biomarkers neuron-specific enolas (NSE) and S100B.METHOD: A prospective observational study was performed in three hospitals in Sweden during 2008-2012. The participants were 125 CA patients treated with therapeutic hypothermia (TH) to 32-34°C for 24hours. Samples were collected from peripheral blood (n=125) and the jugular bulb (n=47) up to 108hours post-CA. GFAP serum levels were quantified using a novel, fully automated immunochemical method. Other biomarkers investigated were NSE and S100B. Neurological outcome was assessed using the Cerebral Performance Categories scale (CPC) and dichotomized into good and poor outcome.RESULTS: GFAP predicted poor neurological outcome with 100% specificity and 14-23% sensitivity at 24, 48 and 72hours post-CA. The corresponding values for NSE were 27-50% sensitivity and for S100B 21-30% sensitivity when specificity was set to 100%. A logistic regression with stepwise combination of the investigated biomarkers, GFAP, did not increase the ability to predict neurological outcome. No differences were found in GFAP, NSE and S100B levels when peripheral and jugular bulb blood samples were compared.CONCLUSION: Serum GFAP increase in patients with poor outcome but did not show sufficient sensitivity to predict neurological outcome after CA. Both NSE and S100B were shown to be better predictors. The ability to predict neurological outcome did not increased when combining the three biomarkers.

    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-229757 (URN)10.1016/j.resuscitation.2014.09.007 (DOI)000346603700010 ()25260722 (PubMedID)
    Tillgänglig från: 2014-08-21 Skapad: 2014-08-12 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    3. Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment
    Öppna denna publikation i ny flik eller fönster >>Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment
    2014 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 2, s. 215-220Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim of the study: To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH).

    Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, at hospital discharge, and at one and 6 months after CA.

    Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0-100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most common complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = -0.44 to -0.71, p = 0.001).

    Conclusion: HRQoL improves over the first 6 months after a CA. Patients reported lower levels of HRQoL on the physical as compared to mental component. The results indicate that the less anxiety and depression patients perceive, the better HRQoL they have and that time can be an important factor in recovery after CA.

    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:uu:diva-211415 (URN)10.1016/j.resuscitation.2013.09.017 (DOI)000332776200019 ()24096198 (PubMedID)
    Tillgänglig från: 2013-11-22 Skapad: 2013-11-22 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
    4. Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia
    Öppna denna publikation i ny flik eller fönster >>Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia
    2013 (Engelska)Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 4, s. 353-359Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM:

    To describe relatives' experiences during the next of kin's hospital stay after surviving a cardiac arrest (CA) treated with hypothermia at an intensive care unit (ICU).

    METHODS:

    Twenty relatives were interviewed when the person having suffered the CA was discharged from hospital, 1.5 to 6 weeks post-CA. Data were analysed using qualitative content analysis.

    RESULTS:

    Three themes are described: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. Relatives found it difficult to assimilate the medical information and wanted it in written form. They wanted honest and clear information about their next of kin's condition and prognosis. They lacked rehabilitation plans after discharge from the medical ward. Relatives felt a need to maintain telephone contact with family members and friends, which was time-consuming. They felt guilty and had a conscience about these feelings. Relatives felt uncertain about the future, but still hopeful.

    CONCLUSION:

    Relatives asked for more information and individual rehabilitation plans. Booklets describing CA, the ICU stay and continuing care and rehabilitation directed at both the patients and their relatives are needed. Follow-up visits to the ICU staff, for both patients and relatives, need to be arranged. Hospitals should consider having a rehabilitation plan for this group of patients, which is presented by a team of healthcare professionals and that focuses on the individual's situation, including the consequences of their heart disease and brain damage.

    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-188154 (URN)10.1177/1474515112459618 (DOI)000322243100006 ()22984190 (PubMedID)
    Tillgänglig från: 2012-12-13 Skapad: 2012-12-13 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
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