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  • 151.
    Holzgraefe, Bernhard
    et al.
    Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.;Arvika Community Hosp, Cty Council Varmland, Dept Anaesthesia Surg Serv & Intens Care Med, Arvika, Sweden..
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    von Kobyletzki, Laura
    Lund Univ, Skane Univ Hosp, Dept Dermatol, Malmo, Sweden.;Karlstad Univ, Dept Publ Hlth Sci, Karlstad, Sweden..
    Do we have scientific evidence about the effect of hypoxaemia on cognitive outcome in adult patients with severe acute respiratory failure?2018Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 1, s. 68-70Artikel i tidskrift (Refereegranskat)
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  • 152. Horna Strand, A
    et al.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Huss, Fredrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Mani, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Epidermal exfoliation of over 95 % after a burn in an 18-month-old boy: a case report and a literature review.2015Ingår i: Annals of Burns and Fire Disasters, ISSN 1121-1539, E-ISSN 1592-9558, Vol. 28Artikel i tidskrift (Refereegranskat)
  • 153.
    Horst, Sandra
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rasmusson, J
    Department of Anesthesiology and Intensive Care, Gävle County Hospital, Gävle, Sweden.
    Pikwer, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Castegren, M
    Perioperative Medicine and Intensive Care, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, 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.
    Impact of resuscitation fluid bag size availability on volume of fluid administration in the intensive care unit2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 9, s. 1261-1266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Iatrogenic fluid overload is associated with increased mortality in the intensive care unit (ICU). Decisions on fluid therapy may, at times, be based on other factors than physiological endpoints. We hypothesized that because of psychological factors volume of available fluid bags would affect the amount of resuscitation fluid administered to ICU patients.

    METHODS: We performed a prospective intervention cross-over study at 3 Swedish ICUs by replacing the standard resuscitation fluid bag of Ringer's Acetate 1000 mL with 500 mL bags (intervention group) for 5 separate months and then compared it with the standard bag size for 5 months (control group). Primary endpoint was the amount of Ringer's Acetate per patient during ICU stay. Secondary endpoints were differences between the groups in cumulative fluid balance and change in body weight, hemoglobin and creatinine levels, urine output, acute kidney failure (measured as the need for renal replacement therapy, RRT) and 90-day mortality.

    RESULTS: Six hundred and thirty-five ICU patients were included (291 in the intervention group, 344 in the control group). There was no difference in the amount of resuscitation fluid per patient during the ICU stay (2200 mL [1000-4500 median IQR] vs 2245 mL [1000-5630 median IQR]), RRT rate (11 vs 9%), 90-day mortality (11 vs 10%) or total fluid balance between the groups. The daily amount of Ringer's acetate administered per day was lower in the intervention group (1040 (280-2000) vs 1520 (460-3000) mL; P = .03).

    CONCLUSIONS: The amount of resuscitation fluid administered to ICU patients was not affected by the size of the available fluid bags. However, altering fluid bag size could have influenced fluid prescription behavior.

  • 154.
    Howells, Tim
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Johnson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    McKelvey, Tomas
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    An optimal frequency range for assessing the pressure reactivity index in patients with traumatic brain injury2015Ingår i: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 29, nr 1, s. 97-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to identify the optimal frequency range for computing the pressure reactivity index (PRx). PRx is a clinical method for assessing cerebral pressure autoregulation based on the correlation of spontaneous variations of arterial blood pressure (ABP) and intracranial pressure (ICP). Our hypothesis was that optimizing the methodology for computing PRx in this way could produce a more stable, reliable and clinically useful index of autoregulation status. The patients studied were a series of 131 traumatic brain injury patients. Pressure reactivity indices were computed in various frequency bands during the first 4 days following injury using bandpass filtering of the input ABP and ICP signals. Patient outcome was assessed using the extended Glasgow Outcome Scale (GOSe). The optimization criterion was the strength of the correlation with GOSe of the mean index value over the first 4 days following injury. Stability of the indices was measured as the mean absolute deviation of the minute by minute index value from 30-min moving averages. The optimal index frequency range for prediction of outcome was identified as 0.018-0.067 Hz (oscillations with periods from 55 to 15 s). The index based on this frequency range correlated with GOSe with rho = -0.46 compared to -0.41 for standard PRx, and reduced the 30-min variation by 23 %.

  • 155.
    Howells, Tim
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Smielewski, Peter
    Univ Cambridge, Addenbrookes Hosp, Dept Clin Neurosci, Neurosurg Unit,Div Anaesthesia, Cambridge, England..
    Donnelly, Joseph
    Univ Cambridge, Addenbrookes Hosp, Dept Clin Neurosci, Neurosurg Unit,Div Anaesthesia, Cambridge, England..
    Czosnyka, Marek
    Univ Cambridge, Addenbrookes Hosp, Dept Clin Neurosci, Neurosurg Unit,Div Anaesthesia, Cambridge, England.;Warsaw Univ Technol, Inst Elect Syst, Warsaw, Poland..
    Hutchinson, Peter J. A.
    Univ Cambridge, Addenbrookes Hosp, Dept Clin Neurosci, Neurosurg Unit,Div Anaesthesia, Cambridge, England..
    Menon, David K.
    Univ Cambridge, Addenbrookes Hosp, Div Anaesthesia, Cambridge, England..
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Aries, Marcel J. H.
    Maastricht Univ, Med Ctr, Dept Crit Care, Maastricht, Netherlands..
    Optimal Cerebral Perfusion Pressure in Centers With Different Treatment Protocols2018Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 46, nr 3, s. e235-e241Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The three centers in this study have different policies regarding cerebral perfusion pressure targets and use of vasopressors in traumatic brain injury patients. The aim was to determine if the different policies affected the estimation of cerebral perfusion pressure which optimizes the strength of cerebral autoregulation, termed "optimal cerebral perfusion pressure." Design: Retrospective analysis of prospectively collected data. Setting: Three neurocritical care units at university hospitals in Cambridge, United Kingdom, Groningen, the Netherlands, and Uppsala, Sweden. Patients: A total of 104 traumatic brain injury patients were included: 35 each from Cambridge and Groningen, and 34 from Uppsala. Interventions: None. Measurements and Main Results: In Groningen, the cerebral perfusion pressure target was greater than or equal to 50 and less than 70mm Hg, in Uppsala greater than or equal to 60, and in Cambridge greater than or equal to 60 or preferably greater than or equal to 70. Despite protocol differences, median cerebral perfusion pressure for each center was above 70mm Hg. Optimal cerebral perfusion pressure was calculated as previously published and implemented in the Intensive Care Monitoring+ software by the Cambridge group, now replicated in the Odin software in Uppsala. Periods with cerebral perfusion pressure above and below optimal cerebral perfusion pressure were analyzed, as were absolute difference between cerebral perfusion pressure and optimal cerebral perfusion pressure and percentage of monitoring time with a valid optimal cerebral perfusion pressure. Uppsala had the highest cerebral perfusion pressure/optimal cerebral perfusion pressure difference. Uppsala patients were older than the other centers, and age is positively correlated with cerebral perfusion pressure/optimal cerebral perfusion pressure difference. Optimal cerebral perfusion pressure was significantly lower in Groningen than in Cambridge. There were no significant differences in percentage of monitoring time with valid optimal cerebral perfusion pressure. Summary optimal cerebral perfusion pressure curves were generated for the combined patient data for each center. These summary curves could be generated for Groningen and Cambridge, but not Uppsala. The older age of the Uppsala patient cohort may explain the absence of a summary curve. Conclusions: Differences in optimal cerebral perfusion pressure calculation were found between centers due to demographics (age) and treatment (cerebral perfusion pressure targets). These factors should be considered in the design of trials to determine the efficacy of autoregulation-guided treatment.

  • 156.
    Hultström, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi.
    In-common molecular pathway for six different etiologies of acute kidney injury2017Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, nr 8, s. 1041-1041Artikel i tidskrift (Övrigt vetenskapligt)
  • 157.
    Huss, Fredrik
    et al.
    Inst för Experimentell och Klinisk medicin, Linköping.
    Erlandsson, Ulf
    Räddningsverket.
    Cooray, Vernon
    Uppsala universitet, Teknisk-naturvetenskapliga vetenskapsområdet, Tekniska sektionen, Institutionen för teknikvetenskaper, Elektricitetslära.
    Kratz, Gunnar
    Inst för Experimentell och Klinisk medicin, Linköping.
    Sjöberg, Folke
    Inst för Experimentell och Klinisk medicin, Linköping.
    [Lightning injuries--a mixture of electrical, thermal and multiple trauma].2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, nr 28-29, s. 2328-31Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    There are several misconceptions even among hospital personnel regarding damages and injuries caused by lightning. Few health care providers have experience from lightning injuries as they are rare and different (DC) from the more common high-voltage (AC) injuries. Furthermore, fatalities are uncommon. Burns do occur but are usually minor. Most lightning injuries occur in the summer season during outdoor leisure activities and in the vicinity of a tree or other large structures. In Sweden, on average, approximately seventeen persons per year are hospitalised and 0.2-0.8 persons per million inhabitants and year die due to lightning injuries. The primary treatment follows the general guidelines for other trauma, electrical, and burn injuries, i.e. as is described in the standardised ATLS, ABLS, or A-HLR programmes. However, there are some minor points that are different and may be stressed for a favourable outcome. In this paper these are addressed together with the epidemiology, effects and treatment of lightning injuries that are specific for Sweden. Unfortunately, little is known, apart from what is described in smaller case series, of the long time sequelae experienced by this patient population and further research is therefore particularly warranted in this respect.

  • 158.
    Huss, Fredrik R M
    et al.
    Inst för Experimentell och Klinisk medicin, Linköping.
    Erlandsson, U
    Räddningsverket.
    Sjöberg, F
    Inst för Experimentell och Klinisk medicin, Linköping.
    Buses as fire hazards: a Swedish problem only? Suggestions for fire-prevention measures.2004Ingår i: Journal of Burn Care and Rehabilitation, ISSN 0273-8481, E-ISSN 1534-5939, Vol. 25, nr 4, s. 377-80; discussion 372Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In Sweden, approximately 6% of all human transportation is made via buses. The Swedish Board of Accident Investigation and the Swedish Rescue Services Agency have pointed out repeatedly that buses are potential fire and burn hazards, not only when involved in collisions but also in other circumstances. The number of fire incidents is increasing, especially in newer buses. In conjunction with the Swedish Rescue Services Agency, we examined some of the recent bus fires in Sweden. We did not find any casualties, but the results of our study suggest that casualties as a result of bus fires are imminent unless preventive measures are taken. We also studied experiences from previous bus fires and suggest preventive measures.

  • 159. Hutchinson, Peter J
    et al.
    Jalloh, Ibrahim
    Helmy, Adel
    Carpenter, Keri L H
    Rostami, Elham
    Participants of the 2014 International Microdialysis ForumUniversity of Cambridge, Cambridge, UK.
    Bellander, Bo-Michael
    Boutelle, Martyn G
    Chen, Jeff W
    Claassen, Jan
    Dahyot-Fizelier, Claire
    Enblad, Per
    Gallagher, Clare N
    Helbok, Raimund
    Hillered, Lars
    Le Roux, Peter D
    Magnoni, Sandra
    Mangat, Halinder S
    Menon, David K
    Nordström, Carl-Henrik
    O'Phelan, Kristine H
    Oddo, Mauro
    Perez Barcena, Jon
    Robertson, Claudia
    Ronne-Engström, Elisabeth
    Sahuquillo, Juan
    Smith, Martin
    Stocchetti, Nino
    Belli, Antonio
    Carpenter, T Adrian
    Coles, Jonathan P
    Czosnyka, Marek
    Dizdar, Nil
    Goodman, J Clay
    Gupta, Arun K
    Nielsen, Troels H
    Marklund, Niklas
    Montcriol, Ambroise
    O'Connell, Mark T
    Poca, Maria A
    Sarrafzadeh, Asita
    Shannon, Richard J
    Skjøth-Rasmussen, Jane
    Smielewski, Peter
    Stover, John F
    Timofeev, Ivan
    Vespa, Paul
    Zavala, Elizabeth
    Ungerstedt, Urban
    Consensus statement from the 2014 International Microdialysis Forum2015Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 41, nr 9, s. 1517-1528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Microdialysis enables the chemistry of the extracellular interstitial space to be monitored. Use of this technique in patients with acute brain injury has increased our understanding of the pathophysiology of several acute neurological disorders. In 2004, a consensus document on the clinical application of cerebral microdialysis was published. Since then, there have been significant advances in the clinical use of microdialysis in neurocritical care. The objective of this review is to report on the International Microdialysis Forum held in Cambridge, UK, in April 2014 and to produce a revised and updated consensus statement about its clinical use including technique, data interpretation, relationship with outcome, role in guiding therapy in neurocritical care and research applications.

  • 160.
    Hvarfner, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Mora Hosp, Mora, Region Dalarna, Sweden.
    Blixt, Jonas
    Karolinska Univ Hosp, Perioperat Med & Intens Care, Stockholm, Sweden;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Schell, Carl Otto
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden;Nykoping Hosp, Dept Internal Med, Nykoping, Region Sormland, Sweden.
    Castegren, Markus
    Karolinska Univ Hosp, Perioperat Med & Intens Care, Stockholm, Sweden;Karolinska Inst, CLINTEC, Stockholm, Sweden.
    Lugazia, Edwin R.
    Muhimbili Natl Hosp, Dept Anaesthesiol, Dar Es Salaam, Tanzania;Muhimbili Univ Hlth & Allied Sci, Dept Anaesthesiol, Dar Es Salaam, Tanzania.
    Mulungu, Moses
    Muhimbili Natl Hosp, Dept Anaesthesiol, Dar Es Salaam, Tanzania.
    Litorp, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden.
    Baker, Tim
    Karolinska Univ Hosp, Perioperat Med & Intens Care, Stockholm, Sweden;Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden;Coll Med, Blantyre, Malawi.
    Vital Signs Directed Therapy for the Critically Ill: Improved Adherence to the Treatment Protocol Two Years after Implementation in an Intensive Care Unit in Tanzania2020Ingår i: Emergency Medicine International, ISSN 2090-2840, E-ISSN 2090-2859, Vol. 2020, artikel-id 4819805Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Treating deranged vital signs is a mainstay of critical care throughout the world. In an ICU in a university hospital in Tanzania, the implementation of the Vital Signs Directed Therapy Protocol in 2014 led to an increase in acute treatments for deranged vital signs. The mortality rate for hypotensive patients decreased from 92% to 69%. In this study, the aim was to investigate the sustainability of the implementation two years later. An observational, patient-record-based study was conducted in the ICU in August 2016. Data on deranged vital signs and acute treatments were extracted from the patients' charts. Adherence to the protocol, defined as an acute treatment in the same or subsequent hour following a deranged vital sign, was calculated and compared with before and immediately after implementation. Two-hundred and eighty-nine deranged vital signs were included. Adherence was 29.8% two years after implementation, compared with 16.6% (p<0.001) immediately after implementation and 2.9% (p<0.001) before implementation. Consequently, the implementation of the Vital Signs Directed Therapy Protocol appears to have led to a sustainable increase in the treatment of deranged vital signs. The protocol may have potential to improve patient safety in other settings where critically ill patients are managed.

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  • 161.
    Hällsjö Sander, Caroline
    et al.
    Karolinska Univ Hosp, Dept Anaesthesiol Surg Serv & Intens Care Med, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    Sigmundsson, Thorir
    Karolinska Univ Hosp, Dept Anaesthesiol Surg Serv & Intens Care Med, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    Hallbäck, Magnus
    Maquet Crit Care AB, Solna, Sweden..
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Inst Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain..
    Wallin, Mats
    Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.;Maquet Crit Care AB, Solna, Sweden..
    Oldner, Anders
    Karolinska Univ Hosp, Dept Anaesthesiol Surg Serv & Intens Care Med, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    Björne, Hakan
    Karolinska Univ Hosp, Dept Anaesthesiol Surg Serv & Intens Care Med, S-17176 Stockholm, Sweden.;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden..
    A modified breathing pattern improves the performance of a continuous capnodynamic method for estimation of effective pulmonary blood flow2017Ingår i: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 31, nr 4, s. 717-725Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a previous study a new capnodynamic method for estimation of effective pulmonary blood flow (COEPBF) presented a good trending ability but a poor agreement with a reference cardiac output (CO) measurement at high levels of PEEP. In this study we aimed at evaluating the agreement and trending ability of a modified COEPBF algorithm that uses expiratory instead of inspiratory holds during CO and ventilatory manipulations. COEPBF was evaluated in a porcine model at different PEEP levels, tidal volumes and CO manipulations (N = 8). An ultrasonic flow probe placed around the pulmonary trunk was used for CO measurement. We tested the COEPBF algorithm using a modified breathing pattern that introduces cyclic end-expiratory time pauses. The subsequent changes in mean alveolar fraction of carbon dioxide were integrated into a capnodynamic equation and effective pulmonary blood flow, i.e. non-shunted CO, was calculated continuously breath by breath. The overall agreement between COEPBF and the reference method during all interventions was good with bias (limits of agreement) 0.05 (-1.1 to 1.2) L/min and percentage error of 36 %. The overall trending ability as assessed by the four-quadrant and the polar plot methodology was high with a concordance rate of 93 and 94 % respectively. The mean polar angle was 0.4 (95 % CI -3.7 to 4.5)A degrees. A ventilatory pattern recurrently introducing end-expiratory pauses maintains a good agreement between COEPBF and the reference CO method while preserving its trending ability during CO and ventilatory alterations.

  • 162.
    Härgestam, Maria
    et al.
    Umeå universitet, Institutionen för omvårdnad.
    Hultin, Magnus
    Umeå universitet, Anestesiologi och intensivvård.
    Brulin, Christine
    Umeå universitet, Institutionen för omvårdnad.
    Jacobsson, Maritha
    Umeå universitet, Institutionen för socialt arbete.
    Trauma team leaders' non-verbal communication: video registration during trauma team training2016Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training.

    METHODS: Eighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members' positions and the leaders' non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders' gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time.

    RESULTS: The team leaders who gained control over the most important area in the emergency room, the "inner circle", positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader's tasks.

    DISCUSSION:

    In teams where the leader had control over the inner circle, the members seemed to have an awareness of each other's roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders' communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety.

    CONCLUSIONS: Non-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.

  • 163.
    Höstman, Staffan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Minimal volume ventilation in lung injury: With special reference to apnea and buffer treatment2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    A fairly large portion of patients receiving surgical or intensive care will need mechanical ventilation at some point. The potential ventilator-induced lung injury (VILI) is thus of interest. One of the main causal factors in VILI is the cyclic energy shifts, i.e. tidal volumes, in the lung during mechanical ventilation. The problem can be approached in two ways. Firstly, one can utilize apneic oxygenation and thus not cause any tidal injuries at all. Secondly, and more traditionally, one can simply lower the tidal volumes and respiratory rates used. The following describes a series of animal experiments exploring these options.

    In the first two papers, I explored and improved upon the methodology of apneic oxygenation. There is a generally held belief that it is only possible to perform apneic oxygenation by prior denitrogenation and by using 100% oxygen during the apnea. As 100% oxygen is toxic, this has prevented apneic oxygenation from more widespread use. The first paper proves that it is indeed possible to perform apneic oxygenation with less than 100% oxygen. I also calculated the alveolar nitrogen concentration which would conversely give the alveolar oxygen concentration. The second paper addresses the second large limitation of apneic oxygenation, i.e. hypercapnia. Using a high dose infusion of tris(hydroxymethyl)aminomethane (THAM) buffer, a pH > 7.2 could be maintained during apneic oxygenation for more than 4.5 hours.

    In the last two papers, THAM’s properties as a proton acceptor are explored during respiratory acidosis caused by very low volume ventilation. In paper III, I found that THAM does not, in the long term, affect pH in respiratory acidosis after stopping the THAM infusion. It does, however, lower PVR, even though the PaCO2 of THAM-treated animals had rebounded to levels higher than that of the controls. In the last experiment, I used volumetric capnography to confirm our hypothesis that carbon dioxide elimination through the lungs was lower during the THAM infusion. Again, the PaCO2 rebounded after the THAM infusion had stopped and I concluded that renal elimination of protonated THAM was not sufficient.

    Delarbeten
    1. Non-toxic alveolar oxygen concentration without hypoxemia during apnoeic oxygenation: an experimental study
    Öppna denna publikation i ny flik eller fönster >>Non-toxic alveolar oxygen concentration without hypoxemia during apnoeic oxygenation: an experimental study
    Visa övriga...
    2011 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, nr 9, s. 1078-1084Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Oxygenation without tidal breathing, i.e. apnoeic oxygenation in combination with extracorporeal carbon dioxide removal, might be an option in the treatment of acute respiratory failure. However, ventilation with 100% O(2), which is potentially toxic, is considered a prerequisite to ensure acceptable oxygenation. We hypothesized that trapping nitrogen (N(2)) in the lungs before the start of apnoeic oxygenation would keep the alveolar O(2) at a non-toxic level and still maintain normoxaemia. The aim was to test whether a predicted N(2) concentration would agree with a measured concentration at the end of an apnoeic period. Methods: Seven anaesthetized, muscle relaxed, endotracheally intubated pigs (22-27 kg) were ventilated in a randomized order with an inspired fraction of O(2) 0.6 and 0.8 at two positive end-expiratory pressure levels (5 cm and 10 cm H(2)O) before being connected to continuous positive airway pressure using 100% O(2) for apnoeic oxygenation. N(2) was measured before the start of and at the end of the 10-min apnoeic period. The predicted N(2) concentration was calculated from the initial N(2) concentration, the end-expiratory lung volume, and the anatomical dead space. Results: The mean difference and standard deviation between measured and predicted N(2) concentration was -0.5 +/- 2%, P = 0.587. No significant difference in the agreement between measured and predicted N(2) concentrations was seen in the four settings. Conclusions: This study indicates that it is possible to predict and keep alveolar N(2) concentration at a desired level and, thus, alveolar O(2) concentration at a non-toxic level during apnoeic oxygenation.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-160124 (URN)10.1111/j.1399-6576.2011.02499.x (DOI)000295102500006 ()
    Tillgänglig från: 2011-10-17 Skapad: 2011-10-17 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
    2. Intensive buffering can keep pH above 7.2 for over 4 h during apnea: an experimental porcine study
    Öppna denna publikation i ny flik eller fönster >>Intensive buffering can keep pH above 7.2 for over 4 h during apnea: an experimental porcine study
    2013 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, nr 1, s. 63-70Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND:

    Ventilation with low tidal volumes reduces mortality in acute respiratory distress syndrome. A further reduction of tidal volumes might be beneficial, and it is known that apneic oxygenation (no tidal volumes) with arteriovenous CO(2) removal can keep acid-base balance and oxygenation normal for at least 7 h in an acute lung injury model. We hypothesized that adequate buffering might be another approach and tested whether tris-hydroxymethyl aminomethane (THAM) alone could keep pH at a physiological level during apneic oxygenation for 4 h.

    METHODS:

    Six pigs were anesthetized, muscle relaxed, and normoventilated. The lungs were recruited, and apneic oxygenation as well as administration of THAM, 20 mmol/kg/h, was initiated. The experiment ended after 270 min, except one that was studied for 6 h.

    RESULTS:

    Two animals died before the end of the experiment. Arterial pH and arterial carbon dioxide tension (PaCO(2) ) changed from 7.5 (7.5, 7.5) to 7.3 (7.2, 7.3) kPa, P < 0.001 at 270 min, and from 4.5 (4.3, 4.7) to 25 (22, 28) kPa, P < 0.001, respectively. Base excess increased from 5 (3, 6) to 54 (51, 57) mM, P < 0.001. Cardiac output and arterial pressure were well maintained. The pig, which was studied for 6 h, had pH 7.27 and PaCO(2) 27 kPa at that time.

    CONCLUSION:

    With intensive buffering using THAM, pH can be kept in a physiologically acceptable range for 4 h during apnea.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Klinisk fysiologi
    Identifikatorer
    urn:nbn:se:uu:diva-188729 (URN)10.1111/aas.12012 (DOI)000312271800009 ()23167283 (PubMedID)
    Tillgänglig från: 2012-12-19 Skapad: 2012-12-19 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
    3. THAM reduces CO2-associated increase in pulmonary vascular resistance: an experimental study in lung-injured piglets
    Öppna denna publikation i ny flik eller fönster >>THAM reduces CO2-associated increase in pulmonary vascular resistance: an experimental study in lung-injured piglets
    Visa övriga...
    2015 (Engelska)Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, nr 1, artikel-id 331Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    INTRODUCTION: Low tidal volume (VT) ventilation is recommended in patients with acute respiratory distress syndrome (ARDS). This may increase arterial carbon dioxide tension (PaCO2), decrease pH, and augment pulmonary vascular resistance (PVR). We hypothesized that Tris(hydroxymethyl)aminomethane (THAM), a pure proton acceptor, would dampen these effects, preventing the increase in PVR.

    METHODS: A one-hit injury ARDS model was established by repeated lung lavages in 18 piglets. After ventilation with VT of 6 ml/kg to maintain normocapnia, VT was reduced to 3 ml/kg to induce hypercapnia. Six animals received THAM for 1 h, six for 3 h, and six serving as controls received no THAM. In all, the experiment continued for 6 h. The THAM dosage was calculated to normalize pH and exhibit a lasting effect. Gas exchange, pulmonary, and systemic hemodynamics were tracked. Inflammatory markers were obtained at the end of the experiment.

    RESULTS: In the controls, the decrease in VT from 6 to 3 ml/kg increased PaCO2 from 6.0±0.5 to 13.8±1.5 kPa and lowered pH from 7.40±0.01 to 7.12±0.06, whereas base excess (BE) remained stable at 2.7±2.3 mEq/L to 3.4±3.2 mEq/L. In the THAM groups, PaCO2 decreased and pH increased above 7.4 during the infusions. After discontinuing the infusions, PaCO2 increased above the corresponding level of the controls (15.2±1.7 kPa and 22.6±3.3 kPa for 1-h and 3-h THAM infusions, respectively). Despite a marked increase in BE (13.8±3.5 and 31.2±2.2 for 1-h and 3-h THAM infusions, respectively), pH became similar to the corresponding levels of the controls. PVR was lower in the THAM groups (at 6 h, 329±77 dyn∙s/m(5) and 255±43 dyn∙s/m(5) in the 1-h and 3-h groups, respectively, compared with 450±141 dyn∙s/m(5) in the controls), as were pulmonary arterial pressures.

    CONCLUSIONS: The pH in the THAM groups was similar to pH in the controls at 6 h, despite a marked increase in BE. This was due to an increase in PaCO2 after stopping the THAM infusion, possibly by intracellular release of CO2. Pulmonary arterial pressure and PVR were lower in the THAM-treated animals, indicating that THAM may be an option to reduce PVR in acute hypercapnia.

    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Anestesiologi och intensivvård; Fysiologi
    Identifikatorer
    urn:nbn:se:uu:diva-264209 (URN)10.1186/s13054-015-1040-4 (DOI)000361433900001 ()26376722 (PubMedID)
    Forskningsfinansiär
    Vetenskapsrådet, K2015-99X-22731-01-4Hjärt-Lungfonden
    Tillgänglig från: 2015-10-07 Skapad: 2015-10-07 Senast uppdaterad: 2017-12-01Bibliografiskt granskad
    4. THAM administration reduces pulmonary carbon dioxide elimination, causing rebound in arterial carbon dioxide tension: An experimental study in hypoventilated pigs
    Öppna denna publikation i ny flik eller fönster >>THAM administration reduces pulmonary carbon dioxide elimination, causing rebound in arterial carbon dioxide tension: An experimental study in hypoventilated pigs
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-304710 (URN)
    Tillgänglig från: 2016-10-08 Skapad: 2016-10-07 Senast uppdaterad: 2016-10-16
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  • 164.
    Höstman, Staffan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Borges, João Batista
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Ahlgren, Kerstin M
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Engström, Joakim
    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, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    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.
    THAM reduces CO2-associated increase in pulmonary vascular resistance: an experimental study in lung-injured piglets2015Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, nr 1, artikel-id 331Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Low tidal volume (VT) ventilation is recommended in patients with acute respiratory distress syndrome (ARDS). This may increase arterial carbon dioxide tension (PaCO2), decrease pH, and augment pulmonary vascular resistance (PVR). We hypothesized that Tris(hydroxymethyl)aminomethane (THAM), a pure proton acceptor, would dampen these effects, preventing the increase in PVR.

    METHODS: A one-hit injury ARDS model was established by repeated lung lavages in 18 piglets. After ventilation with VT of 6 ml/kg to maintain normocapnia, VT was reduced to 3 ml/kg to induce hypercapnia. Six animals received THAM for 1 h, six for 3 h, and six serving as controls received no THAM. In all, the experiment continued for 6 h. The THAM dosage was calculated to normalize pH and exhibit a lasting effect. Gas exchange, pulmonary, and systemic hemodynamics were tracked. Inflammatory markers were obtained at the end of the experiment.

    RESULTS: In the controls, the decrease in VT from 6 to 3 ml/kg increased PaCO2 from 6.0±0.5 to 13.8±1.5 kPa and lowered pH from 7.40±0.01 to 7.12±0.06, whereas base excess (BE) remained stable at 2.7±2.3 mEq/L to 3.4±3.2 mEq/L. In the THAM groups, PaCO2 decreased and pH increased above 7.4 during the infusions. After discontinuing the infusions, PaCO2 increased above the corresponding level of the controls (15.2±1.7 kPa and 22.6±3.3 kPa for 1-h and 3-h THAM infusions, respectively). Despite a marked increase in BE (13.8±3.5 and 31.2±2.2 for 1-h and 3-h THAM infusions, respectively), pH became similar to the corresponding levels of the controls. PVR was lower in the THAM groups (at 6 h, 329±77 dyn∙s/m(5) and 255±43 dyn∙s/m(5) in the 1-h and 3-h groups, respectively, compared with 450±141 dyn∙s/m(5) in the controls), as were pulmonary arterial pressures.

    CONCLUSIONS: The pH in the THAM groups was similar to pH in the controls at 6 h, despite a marked increase in BE. This was due to an increase in PaCO2 after stopping the THAM infusion, possibly by intracellular release of CO2. Pulmonary arterial pressure and PVR were lower in the THAM-treated animals, indicating that THAM may be an option to reduce PVR in acute hypercapnia.

  • 165.
    Höstman, Staffan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Perchiazzi, Gaetano
    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.
    THAM administration reduces pulmonary carbon dioxide elimination, causing rebound in arterial carbon dioxide tension: An experimental study in hypoventilated pigsManuskript (preprint) (Övrigt vetenskapligt)
  • 166.
    Höstman, Staffan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Perchiazzi, Gaetano
    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.
    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.
    THAM administration reduces pulmonary carbon dioxide elimination in hypercapnia: an experimental porcine study2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 6, s. 820-828Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In a previous study, we found a rebound of arterial carbon dioxide tension (PaCO2) after stopping THAM buffer administration. We hypothesized that this was due to reduced pulmonary CO2 elimination during THAM administration. The aim of this study was to investigate this hypothesis in an experimental porcine hypercapnic model.

    Methods: In seven, initially normoventilated, anesthetized pigs (22-27 kg) minute ventilation was reduced by 66% for 7 h. Two hours after commencing hypoventilation, THAM was infused IV for 3 h in a dose targeting a pH of 7.35 followed by a 2 h observation period. Acid-base status, blood-gas content and exhaled CO2 were measured.

    Results: THAM raised pH (7.07 0.04 to 7.41 +/- 0.04, P < 0.05) and lowered PaCO2 (15.2 +/- 1.4 to 12.2 +/- 1.1 kPa, P < 0.05). After the infusion, pH decreased and PaCO2 increased again. At the end of the observation period, pH and PaCO2 were 7.24 +/- 0.03 and 16.6 +/- 1.2 kPa, respectively (P < 0.05). Pulmonary CO2 excretion decreased from 109 +/- 12 to 74 +/- 12 ml/min (P < 0.05) during the THAM infusion but returned at the end of the observation period to 111 +/- 15 ml/min (P < 0.05). The estimated reduction of pulmonary CO2 elimination during the infusion was 5800 ml.

    Conclusions: In this respiratory acidosis model, THAM reduced PaCO2, but seemed not to increase the total CO2 elimination due to decreased pulmonary CO2 excretion(,) suggesting only cautious use of THAM in hypercapnic acidosis.

  • 167.
    Israelsson, Johan
    et al.
    Kalmar Cty Hosp, Div Cardiol, Dept Internal Med, S-39185 Kalmar, Sweden.;Linnaeus Univ, Kalmar Maritime Acad, Kalmar, Sweden.;Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Bremer, Anders
    Univ Boras, Ctr Prehosp Res, Dept Acute & Prehosp Care & Med Technol & PreHosp, Boras, Sweden.;Kalmar Cty Hosp, Div Emergency Med Serv, Kalmar, Sweden..
    Herlitz, Johan
    Univ Boras, Ctr Prehosp Res, Dept Acute & Prehosp Care & Med Technol & PreHosp, Boras, Sweden..
    Axelsson, Asa B.
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Gothenburg, Sweden..
    Cronberg, Tobias
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Neurol, Lund, Sweden..
    Djarv, Therese
    Karolinska Inst, Dept Med Solna, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm, Sweden..
    Kristofferzon, Marja-Leena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Univ Gavle, Fac Hlth & Occupat Studies, Dept Hlth & Caring Sci, Gavle, Sweden..
    Larsson, Ing-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lilja, Gisela
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Neurol, Lund, Sweden..
    Sunnerhagen, Katharina S.
    Univ Gothenburg, Inst Neurosci & Physiol, Sect Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Wallin, Ewa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Agren, Susanna
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.;Cty Council Ostergotland, Dept Cardiothorac Surg, Linkoping, Sweden..
    Akerman, Eva
    Skane Univ Hosp, Dept Perioperat Med & Intens Care, Malmo, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Arestedt, Kristofer
    Linnaeus Univ, Fac Hlth & Life Sci, Kalmar, Sweden.;Ersta Skondal Univ Coll, Dept Hlth Care Sci, Stockholm, Sweden.;Kalmar Cty Hosp, Dept Res, Kalmar, Sweden..
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, s. 27-33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe health status and psychological distress among in -hospital cardiac arrest (IHCA) survivors in relation to gender. Methods: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQVAS among survivors were 0.78 (ql-q3 = 0.67-0.86) and 70 (ql -q3 = 50-80) respectively. The values were significantly lower (p < 0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self -care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p < 0.001) and symptoms of depression (p < 0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found. Conclusions: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed. (C) 2017 Elsevier B.V. All rights reserved.

  • 168. Jalkanen, V.
    et al.
    Yang, R.
    Vaahersalo, J.
    Kurola, J.
    Ruokonen, E.
    Huhtala, H.
    Kuitunen, A.
    Pettila, V.
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Low Serum Super Concentration Predicts 90-Day Survival after Out-Of-Hospital Cardiac Arrest2014Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 40, s. S213-S214Artikel i tidskrift (Övrigt vetenskapligt)
  • 169. Jalkanen, Ville
    et al.
    Vaahersalo, Jukka
    Pettila, Ville
    Kurola, Jouni
    Varpula, Tero
    Tiainen, Marjaana
    Huhtala, Heini
    Alaspaa, Ari
    Hovilehto, Seppo
    Kiviniemi, Outi
    Kuitunen, Anne
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    The predictive value of soluble urokinase plasminogen activator receptor (SuPAR) regarding 90-day mortality and 12-month neurological outcome in critically ill patients after out-of-hospital cardiac arrest. Data from the prospective FINNRESUSCI study2014Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 11, s. 1562-1567Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The whole body ischaemia-reperfusion after cardiac arrest (CA) induces a systemic inflammation-reperfusion response. The expression of urokinase plasminogen activator receptor (uPAR) is known to be induced after hypoxia and increased levels of soluble form suPAR have been measured after hypoxia and ischaemia. Our aim was to evaluate, whether ischaemia/reperfusion injury after out-of-hospital cardiac arrest (OHCA) increases suPAR concentrations in serum and to evaluate the prognostic value of suPAR regarding 90-day mortality and 12-month neurological outcome. Methods: This is a pre-determined substudy of prospective FINNRESUSCI study. Total of 287 patients treated in the intensive care units after OHCA and with consent from the next-of-kin and serum samples between baseline and day 4 were included. Outcome and neurological outcome were evaluated according the Pittsburgh Cerebral Performance Categories (CPC). Kaplan-Meier survival curves, areas under receiver operational characteristics curves and positive likelihood ratios for mortality and poor neurological outcome were calculated. Results: Non-survivors had higher levels of suPAR after OHCA. Kaplan-Meier survival curves indicated high 90-day mortality in the highest concentration quintiles. LR+ for 1-year CPC 3-5 was 1.8-2.7 for the whole patient cohort and in shockable rhythms 2.0-2.4. In therapeutic hypothermia prognostic value remained. Conclusions: We found that high SuPAR concentrations were associated with poor outcome in patients with OHCA admitted to critical care. However, suPAR alone had inadequate predictive value for poor outcome and did not associate with 12-month neurological outcome.  

  • 170.
    Johansson, Jakob
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Cardiopulmonary Resuscitation: Pharmacological Interventions for Augmentation of Cerebral Blood Flow2004Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Cardiac arrest results in immediate interruption of blood flow. The primary goal of cardiopulmonary resuscitation (CPR) is to re-establish blood flow and hence oxygen delivery to the vital organs. This thesis describes different pharmacological interventions aimed at increasing cerebral blood flow during CPR and after restoration of spontaneous circulation (ROSC).

    In a porcine model of cardiac arrest, continuous infusion of adrenaline generated higher cortical cerebral blood flow during CPR as compared to bolus administration of adrenaline. While bolus doses resulted in temporary peaks in cerebral blood flow, continuous infusion led to a sustained increase in this flow.

    Administration of vasopressin resulted in higher cortical cerebral blood flow and a lower cerebral oxygen extraction ratio as compared to continuous infusion of adrenaline during CPR. In addition, vasopressin generated higher coronary perfusion pressure during CPR and increased the likelihood of achieving ROSC.

    Parameters of coagulation and inflammation were measured after successful resuscitation from cardiac arrest. Immediately after ROSC, thrombin-antithrombin complex, a marker of thrombin generation, was elevated and eicosanoid levels were increased, indicating activation of coagulation and inflammation after ROSC. The thrombin generation was accompanied by a reduction in antithrombin. In addition, there was substantial haemoconcentration in the initial period after ROSC.

    By administration of antithrombin during CPR, supraphysiological levels of antithrombin were achieved. However, antithrombin administration did not increase cerebral circulation or reduce reperfusion injury, as measured by cortical cerebral blood flow, cerebral oxygen extraction and levels of eicosanoids, after ROSC.

    In a clinical study, the adrenaline dose interval was found to be longer than recommended in the majority of cases of cardiac arrest. Thus, the adherence to recommended guidelines regarding the adrenaline dose interval seems to be poor.

    Delarbeten
    1. Increased cortical cerebral blood flow by continuous infusion of epinephrine during experimental cardiopulmonary resuscitation
    Öppna denna publikation i ny flik eller fönster >>Increased cortical cerebral blood flow by continuous infusion of epinephrine during experimental cardiopulmonary resuscitation
    2003 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 57, nr 3, s. 299-307Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To study the effects of continuously administered adrenaline (epinephrine), compared to bolus doses, on the dynamics of cortical cerebral blood flow during experimental cardiopulmonary resuscitation (CPR), and after restoration of spontaneous circulation (ROSC).

    METHODS: Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, closed-chest CPR was started. The animals were randomised into two groups. One group received three boluses of adrenaline (20 microg/kg) at 3-min intervals. The other group received an initial bolus of adrenaline (20 microg/kg) followed by an infusion of adrenaline (10 microg/kg x min). After 9 min of CPR, defibrillation was attempted, and if spontaneous circulation was achieved the adrenaline infusion was stopped. Cortical cerebral blood flow was measured continuously using Laser-Doppler flowmetry. Jugular bulb oxygen saturation was measured to reflect global cerebral oxygenation. Repeated measurements of 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha)) in jugular bulb plasma were performed to evaluate cerebral oxidative injury.

    RESULTS: During CPR mean cortical cerebral blood flow was significantly higher (P=0.009) with a continuous adrenaline infusion than with repeated bolus doses. Following ROSC there was no significant difference in cortical cerebral blood flow between the two study groups. No differences in coronary perfusion pressure, rate of ROSC, jugular bulb oxygen saturation or 8-iso-PGF(2alpha) were seen between the study groups.

    CONCLUSIONS: Continuous infusion of adrenaline (10 microg/kg x min) generated a more sustained increase in cortical cerebral blood flow during CPR as compared to intermittent bolus doses (20 microg/kg every third minute). Thus, continuous infusion might be a more appropriate way to administer adrenaline as compared to bolus doses during CPR.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91827 (URN)10.1016/S0300-9572(03)00031-5 (DOI)12804807 (PubMedID)
    Tillgänglig från: 2004-05-07 Skapad: 2004-05-07 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    2. Vasopressin versus continuous adrenaline during experimental cardiopulmonary resuscitation
    Öppna denna publikation i ny flik eller fönster >>Vasopressin versus continuous adrenaline during experimental cardiopulmonary resuscitation
    2004 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 62, nr 1, s. 61-69Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: To evaluate the effects of a bolus dose of vasopressin compared to continuous adrenaline (epinephrine) infusion on vital organ blood flow during cardiopulmonary resuscitation (CPR). Methods: Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, CPR was started. After 2 min of CPR the animals were randomly assigned to receive either vasopressin (0.4 U/kg) or adrenaline (bolus of 20 μg/kg followed by continuous infusion of 10 μg/(kg min)). Defibrillation was attempted after 9 min of CPR. Results: Vasopressin generated higher cortical cerebral blood flow (P<0.001) and lower cerebral oxygen extraction (P<0.001) during CPR compared to continuous adrenaline. Coronary perfusion pressure during CPR was higher in vasopressin-treated pigs (P<0.001) and successful resuscitation was achieved in 12/12 in the vasopressin group versus 5/12 in the adrenaline group (P=0.005). Conclusions: In this experimental model, vasopressin caused a greater increase in cortical cerebral blood flow and lower cerebral oxygen extraction during CPR compared to continuous adrenaline. Furthermore, vasopressin generated higher coronary perfusion pressure and increased the likelihood of restoring spontaneous circulation.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91828 (URN)10.1016/j.resuscitation.2004.01.034 (DOI)15246585 (PubMedID)
    Tillgänglig från: 2004-05-07 Skapad: 2004-05-07 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    3. Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines
    Öppna denna publikation i ny flik eller fönster >>Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines
    Visa övriga...
    2004 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, nr 7, s. 909-913Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Adrenaline does not appear to improve the outcome after cardiac arrest in clinical trials in spite of beneficial effects in experimental studies. The objective of this study was to determine whether adrenaline was administered in accordance with advanced cardiac life support (ACLS) guidelines during adult cardiopulmonary resuscitation (CPR). METHODS: From 15 January to 31 December 2000, all patients at Uppsala University Hospital in whom CPR was attempted were registered prospectively. The duration of CPR was documented in the register and the total dose of adrenaline was retrieved retrospectively from patient records. From these data the average interval between adrenaline doses was calculated. RESULTS: Data for evaluation of the between-dose interval of adrenaline was available in 53 of 107 registered cardiac arrests. In 68% (36/53) the average between-dose interval was longer than the 3-5 min recommended in the guidelines, and 8% (4/53) received no adrenaline. The median interval between adrenaline doses during CPR was 6.5 min (25th-75th percentile: 5.1-10.4). Adherence to guidelines was lower in out-of-hospital cardiac arrest than in in-hospital cardiac arrest (P = 0.01). CONCLUSIONS: In the majority of cases adrenaline did not appear to be administered according to current ACLS guidelines.

    Nyckelord
    Adult, Aged, Aged; 80 and over, Cardiopulmonary Resuscitation, Epinephrine/*administration & dosage, Female, Humans, Male, Middle Aged, Practice Guidelines, Time Factors
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91829 (URN)10.1111/j.1399-6576.2004.00440.x (DOI)15242439 (PubMedID)
    Tillgänglig från: 2004-05-07 Skapad: 2004-05-07 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    4. Antithrombin reduction after experimental cardiopulmonary resuscitation
    Öppna denna publikation i ny flik eller fönster >>Antithrombin reduction after experimental cardiopulmonary resuscitation
    2003 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 59, nr 2, s. 229-236Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To determine whether activation of coagulation and inflammation during cardiac arrest results in a reduction of antithrombin (AT) and an increase in thrombin-antithrombin (TAT) complex during reperfusion.

    METHODS: Ventricular fibrillation (VF) was induced in ten anaesthetized pigs. After a 5-min non-intervention interval, closed-chest cardiopulmonary resuscitation (CPR) was performed for 9 min before defibrillation was attempted. If restoration of spontaneous circulation (ROSC) was achieved, the animals were observed for 4 h and repeated blood samples were taken for assay of AT, TAT and eicosanoids (8-iso-PGF(2alpha) and 15-keto-dihydro-PGF(2alpha)).

    RESULTS: AT began to decrease 15 min after ROSC and the reduction continued throughout the observation period (P<0.05). The lowest mean value (79%) occurred 60 min after ROSC. The TAT level was increased during the first 3 h after ROSC (P<0.05), indicating thrombin generation. The eicosanoids were increased throughout the observation period (P<0.05).

    CONCLUSIONS: AT is reduced and TAT and eicosanoids are increased after cardiac arrest, indicating activation of coagulation and inflammation.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91830 (URN)10.1016/S0300-9572(03)00182-5 (DOI)14625115 (PubMedID)
    Tillgänglig från: 2004-05-07 Skapad: 2004-05-07 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    5. Antithrombin administration during experimental cardiopulmonary resuscitation
    Öppna denna publikation i ny flik eller fönster >>Antithrombin administration during experimental cardiopulmonary resuscitation
    2004 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 62, nr 1, s. 71-78Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To determine whether antithrombin (AT) administration during cardiopulmonary resuscitation (CPR) increased cerebral circulation and reduced reperfusion injury.

    METHODS: Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, CPR was started. The animals were randomised into two groups. The treatment group received AT (250 U/kg) and the control group received placebo, after 7 min of CPR. Defibrillation was attempted after 9 min of CPR. If restoration of spontaneous circulation (ROSC) was achieved, the animals were observed for 4 h. Cortical cerebral blood flow was measured using laser-Doppler flowmetry. Cerebral oxygen extraction was calculated to reflect the relation between global cerebral circulation and oxygen demand. Measurements of eicosanoids (8-iso-PGF(2alpha) and 15-keto-dihydro-PGF(2alpha)), AT, thrombin-antithrombin complex (TAT) and soluble fibrin in jugular bulb plasma were performed to detect any signs of cerebral oxidative injury, inflammation and coagulation.

    RESULTS: There was no difference between the groups in cortical cerebral blood flow, cerebral oxygen extraction, or levels of eicosanoids, TAT or soluble fibrin in jugular bulb plasma after ROSC. In the control group reduction of AT began 15 min after ROSC and continued throughout the entire observation period (P < 0.05). Eicosanoids and TAT were increased compared to baseline in all animals (P < 0.01).

    CONCLUSIONS: In this experimental model of CPR, AT administration did not increase cerebral circulation or reduce reperfusion injury after ROSC.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91831 (URN)10.1016/j.resuscitation.2004.02.010 (DOI)15246586 (PubMedID)
    Tillgänglig från: 2004-05-07 Skapad: 2004-05-07 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
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  • 171. Johansson, Joakim
    et al.
    Sjöberg, Jonas
    Nordgren, Marie
    Sandstrom, Erik
    Sjöberg, Folke
    Zetterström, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Prehospital analgesia using nasal administration of S-ketamine: a case series2013Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, artikel-id 38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 172.
    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.

  • 173.
    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.

  • 174. 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)
  • 175. 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)
  • 176. 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)
  • 177. 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)
  • 178. 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)
  • 179. 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)
  • 180.
    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.

  • 181.
    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.

  • 182.
    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. 

  • 183.
    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.

  • 184.
    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)
  • 185.
    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)
  • 186. 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.

  • 187. 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)
  • 188.
    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.

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  • 189.
    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)
  • 190.
    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
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    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
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    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
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    (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
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  • 191. Kemani, Mike
    et al.
    Zetterqvist, Vendela
    Behavioural Medicine Pain Treatment Services, Pain Center, Karolinska University Hospital, Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
    Kanstrup, Marie
    Holmström, Linda
    Wicksell, Rikard
    A validation of the Pain Interference Index in adults with longstanding pain2016Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, nr 2, s. 250-258Artikel i tidskrift (Refereegranskat)
  • 192.
    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.

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  • 193. 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)
  • 194.
    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.

  • 195.
    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.

  • 196.
    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).

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  • 197. 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.

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  • 198. 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)
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  • 199.
    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.

  • 200.
    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
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