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  • 201.
    Knudsen, Kati
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Nilsson, Ulrica
    The best method to predict easy intubation: a quasi-experimental pilot study2014Ingår i: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 29, nr 4, s. 292-297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

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

    DESIGN:

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

    METHODS:

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

    FINDING:

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

    CONCLUSIONS:

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

  • 202.
    Knudsen, Kati
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Högskolan i Gävle, University of Gävle.
    Pöder, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Högman, Marieann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Lungmedicin och allergologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nilsson, Ulrica
    Örebro universitet, Örebro University.
    A nationwide postal questionnaire survey: the presence of airway guidelines in anaesthesia department in Sweden2014Ingår i: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 14, s. 25-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

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  • 203.
    Koga, Itaru
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Monitoring of Splanchnic Regional Perfusion: An Experimental Study of New Application and Validation2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

    Delarbeten
    1. Intraperitoneal and sigmoid colon tonometry in porcine hypoperfusion and endotoxin shock models
    Öppna denna publikation i ny flik eller fönster >>Intraperitoneal and sigmoid colon tonometry in porcine hypoperfusion and endotoxin shock models
    1999 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 43, nr 7, s. 702-707Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-90926 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16 Senast uppdaterad: 2015-06-09Bibliografiskt granskad
    2. Intraperitoneal tonometry for detection of regional enteric ischemia
    Öppna denna publikation i ny flik eller fönster >>Intraperitoneal tonometry for detection of regional enteric ischemia
    2000 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 44, nr 8, s. 985-990Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-90927 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16 Senast uppdaterad: 2015-06-09Bibliografiskt granskad
    3. Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
    Öppna denna publikation i ny flik eller fönster >>Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
    2002 Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 46, nr 10, s. 1212-1216Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-90928 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16Bibliografiskt granskad
    4. Experimental evaluation of hepatic venous oxygen saturation and lactate measurements in varying splanchnic perfusion
    Öppna denna publikation i ny flik eller fönster >>Experimental evaluation of hepatic venous oxygen saturation and lactate measurements in varying splanchnic perfusion
    (Engelska)Manuskript (Övrigt vetenskapligt)
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-90929 (URN)
    Tillgänglig från: 2003-10-16 Skapad: 2003-10-16 Senast uppdaterad: 2015-06-09Bibliografiskt granskad
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  • 204.
    Kostic, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    New methods for optimization of mechanical ventilation2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

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

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-162094 (URN)10.1186/cc10236 (DOI)000295799700008 ()
    Tillgänglig från: 2011-11-24 Skapad: 2011-11-24 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
    4. The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation.
    Öppna denna publikation i ny flik eller fönster >>The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation.
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    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Anestesiologi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-248628 (URN)
    Tillgänglig från: 2015-04-05 Skapad: 2015-04-05 Senast uppdaterad: 2015-07-07
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  • 205.
    Kostic, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lo Mauro, Antonella
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Pedotti, Antonio
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Frykholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Aliverti, Andrea
    Active expiration may contribute to the reduction in end-expiratory volume during emergence from anesthesia and in the immediate post-operative period.Manuskript (preprint) (Övrigt vetenskapligt)
  • 206.
    Kostic, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Milesi, Ilaria
    Zannin, Emanuela
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Frykholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Dellaca, Raffaele L
    The application of forced oscillation technique and self-mixing laser interferometers during anesthesia and mechanical ventilation.Manuskript (preprint) (Övrigt vetenskapligt)
  • 207.
    Krakau, Karolina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Energy Balance out of Balance after Severe Traumatic Brain Injury2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Nyckelord
    Predicted energy expenditure, SenseWear Armband, Indirect calorimetry, Doubly labelled water, Traumatic brain injury
    Nationell ämneskategori
    Näringslära Anestesi och intensivvård Kirurgi Omvårdnad
    Forskningsämne
    Anestesiologi och intensivvård; Nutrition; Omvårdnadsforskning med medicinsk inriktning
    Identifikatorer
    urn:nbn:se:uu:diva-114123 (URN)
    Tillgänglig från: 2010-02-10 Skapad: 2010-02-10 Senast uppdaterad: 2010-02-10
    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 208.
    Krakau, Karolina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Ellegård, Lars
    Department of Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital, Gothenburg.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska University Hospital Solna, Stockholm.
    Karlsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nygren de Boussard, Catharina
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Borg, Jörgen
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Prediction of energy expenditure in patients with severe traumatic brain injury: A validation study by use of continuous indirect calorimetry and doubly labelled waterManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

  • 209.
    Krakau, Karolina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rehabiliteringsmedicin.
    Ellegård, Lars
    Department of Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg and Sahlgrenska University Hospital, Gothenburg.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska University Hospital Solna, Stockholm.
    Karlsson, Torbjörn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nygren de Boussard, Catharina
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Karlsson, Michael
    Danderyd Geriatric Center, Danderyd University Hospital, Stockholm.
    Borg, Jörgen
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm.
    Energy balance and metabolism after severe traumatic brain injury: A pilot study using doubly labelled waterManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

  • 210.
    Kretzschmar, Moritz A.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Univ Magdeburg, Dept Anaesthesiol & Intens Care Med, Leipziger Str 44, D-39120 Magdeburg, Germany..
    Hachenberg, Thomas
    Univ Magdeburg, Dept Anaesthesiol & Intens Care Med, Leipziger Str 44, D-39120 Magdeburg, Germany..
    Thoracic anaesthesia 20162016Ingår i: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 29, nr 1, s. 1-1Artikel i tidskrift (Övrigt vetenskapligt)
  • 211.
    Kretzschmar, Moritz A.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hachenberg, Thomas
    Thoracic anesthesia2015Ingår i: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 28, nr 1, s. 1-1Artikel i tidskrift (Övrigt vetenskapligt)
  • 212.
    Kretzschmar, Moritz Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Ventilation/Perfusion Matching and its Effect on Volatile Pharmacokinetics2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

    Anesthetized and mechanically ventilated piglets were studied.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-334179 (URN)10.1097/ALN.0000000000001847 (DOI)000414634700010 ()28857808 (PubMedID)
    Forskningsfinansiär
    Vetenskapsrådet, X2015-99x-22731-01-04
    Tillgänglig från: 2017-11-21 Skapad: 2017-11-21 Senast uppdaterad: 2018-02-16Bibliografiskt granskad
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  • 213.
    Kretzschmar, Moritz
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Kozian, Alf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Baumgardner, James E
    Oscill LLC, Pittsburgh, PA USA; Univ Pittsburgh, Med Ctr, Dept Anesthesiol, Pittsburgh, PA USA.
    Borges, João Batista
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hachenberg, Thomas
    Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Schilling, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Otto von Guericke Univ, Dept Anesthesia & Intens Care Med, Magdeburg, Germany.
    Effect of Bronchoconstriction-induced Ventilation-Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane2017Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 127, nr 5, s. 800-812Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 214.
    Kvarnström, Ann
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Neuropathic Pain; Quality of Life, Sensory Assessments and Pharmacological Treatments2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-91049 (URN)10.1111/j.1399-6576.2003.00330.x (DOI)15025615 (PubMedID)
    Tillgänglig från: 2003-11-19 Skapad: 2003-11-19 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 215.
    Laake, J. H.
    et al.
    Oslo Univ Hosp, Div Crit Care & Emergencies, Dept Anaesthesiol, Oslo, Norway.
    Tonnessen, T. I.
    Oslo Univ Hosp, Div Crit Care & Emergencies, Dept Anaesthesiol, Oslo, Norway.
    Chew, M. S.
    Linkoping Univ, Dept Anaesthesia & Intens Care, Med & Hlth Sci, Linkoping, Sweden.
    Lipcsey, Miklós
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hjelmqvist, H.
    Orebro Univ, Sch Med Sci, Dept Anaesthesia & Intens Care, Orebro, Sweden;Univ Hosp, Orebro, Sweden.
    Wilkman, E.
    Univ Helsinki, Dept Anaesthesiol Intens Care & Pain Med, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Pettilae, V.
    Univ Helsinki, Dept Anaesthesiol Intens Care & Pain Med, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Hoffmann-Petersen, J.
    Odense Univ Hosp, Dept Anaesthesiol & Intens Care, Odense, Denmark.
    Moller, M. H.
    Copenhagen Univ Hosp, Rigshospi, Dept Intens Care, Copenhagen, Denmark.
    The SSAI fully supports the suspension of hydroxyethyl-starch solutions commissioned by the European Medicines Agency2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 6, s. 874-875Artikel i tidskrift (Övrigt vetenskapligt)
  • 216. Laffey, John G
    et al.
    Bellani, Giacomo
    Pham, Tài
    Fan, Eddy
    Madotto, Fabiana
    Bajwa, Ednan K
    Brochard, Laurent
    Clarkson, Kevin
    Esteban, Andres
    Gattinoni, Luciano
    van Haren, Frank
    Heunks, Leo M
    Kurahashi, Kiyoyasu
    Laake, Jon Henrik
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    McAuley, Daniel F
    McNamee, Lia
    Nin, Nicolas
    Qiu, Haibo
    Ranieri, Marco
    Rubenfeld, Gordon D
    Thompson, B Taylor
    Wrigge, Hermann
    Slutsky, Arthur S
    Pesenti, Antonio
    Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study2016Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, nr 12, s. 1865-1876Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

    TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073.

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

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

  • 218.
    Lagedal, Rickard
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Elfwen, L.
    Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, Solna, Sweden.
    Jonsson, M.
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    Lindgren, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Smekal, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala Univ, Uppsala Ctr Prehosp Res, UCPR, Uppsala, Sweden.
    Svensson, L.
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Nordberg, P.
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Coronary angiographic findings after cardiac arrest in relation to ECG and comorbidity2020Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 146, s. 213-219Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The relations between specific ECG patterns and coronary angiographic findings in cardiac arrest patients with different comorbidities are not properly assessed. More evidence is needed to identify patients with the highest risk for acute coronary artery disease as a cause of the cardiac arrest. This study aims to describe the coronary artery findings after cardiac arrest in relation to ECG and comorbidity.

    Method: A retrospective study of out-of-hospital cardiac arrest patients, with coronary angiography performed within 28 days. ECG on admission, comorbidity, PCI attempts and angiographic findings are described. Data were retrieved from national registries in Sweden.

    Results: Among 1133 patients with available ECG and angiography information the mean age was 64 years. The rate of shockable rhythm was 79 degrees 0. The total incidence of any significant stenosis in cardiac arrest patients without ST-elevation who underwent coronary angiography within 28 days was 71 degrees 0. The incidence of any stenosis in patients with normal ECG was 62.1 degrees 0 and in patients with LBBB, 59.3 degrees 0. In patients with ST-depression or RBBB, PCI attempts were made in 47.1 degrees 0 and 42.4 degrees 0 respectively, compared with 33.3 degrees 0 in patients with normal ECG. Among patients without ST-elevation, those with diabetes mellitus and those with initial shockable rhythm respectively, 84.8 degrees 0 and 71.5 had at least one significant stenosis.

    Conclusion: Our study suggests, that evaluation of ECG patterns and comorbidities in out-of-hospital cardiac arrest patients without ST-segment elevation may be important to identify those with a high risk of coronary artery lesions that could benefit from early revascularization.

  • 219.
    Lagedal, Rickard
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Jonsson, Martin
    Institutionen för medicin, Centrum för hjärtstoppsforskning, Karolinska Institutet.
    Elfwén, Ludwig
    Institutionen för klinisk forskning och utbildning, Södersjukhuset, Karolinska Institutet.
    Smekal, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nordberg, Per
    Institutionen för medicin, Centrum för hjärtstoppsforskning, Karolinska Institutet.
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Income is associated with the probability to receive early coronary angiography after out-of-hospital cardiac arrestManuskript (preprint) (Övrigt vetenskapligt)
  • 220. Larsson, Anders
    et al.
    Barklin, A
    Theodorsson, E
    Tyvold, SS
    Garnfeldt, A
    Sloth, E
    Tonnesen, E
    Alteration of neuropeptides in the lung tissue correlates brain death-induced neurogenic edema2010Ingår i: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, E-ISSN 1557-3117, Vol. 54, s. 199-205Artikel i tidskrift (Refereegranskat)
  • 221.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Kjaergaard, B
    Kristensen, SR
    Risom, M
    A porcine model of massive, totally occlusive, pulmonary embolism2009Ingår i: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 124, s. 226-229Artikel i tidskrift (Refereegranskat)
  • 222.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Smekal, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lipcsey, Miklós
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rapid testing of red blood cells, white blood cells and platelets in intensive care patients using the HemoScreen™ point-of-care analyzer2019Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 30, nr 8, s. 1013-1016Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 223.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Vistisen, ST
    Struijk, JJ
    Automated pre-ejection period variation indexed to tidal volume predicts fluid responsiveness after cardiac surgery2009Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, s. 534-542Artikel i tidskrift (Refereegranskat)
  • 224.
    Larsson, Ing-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Post-Cardiac Arrest Care: Therapeutic Hypothermia, Patient Outcomes and Relatives’ Experiences2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    AIM:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSION:

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

    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-188154 (URN)10.1177/1474515112459618 (DOI)000322243100006 ()22984190 (PubMedID)
    Tillgänglig från: 2012-12-13 Skapad: 2012-12-13 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
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  • 225.
    Larsson, Ing-Marie
    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, Sjuksköterskeutbildningar.
    Wallin, Ewa
    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, Sjuksköterskeutbildningar.
    Kristofferzon, Marja-Leena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Niessner, Maron
    Zetterberg, Henrik
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome2014Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 12, s. 1654-1661Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 226.
    Larsson, Ing-Marie
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Wallin, Ewa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kristofferzon, Marja-Leena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 4, s. 353-359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSION:

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

  • 227.
    Larsson, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Univ Uppsala Hosp, Clin Anaesthesia & Intens Care, Uppsala, Sweden..
    Monitoring the anaesthetist in the operating theatre - professional competence and patient safety2017Ingår i: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 72, s. 76-83Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    This article about competence and patient safety in anaesthesia was inspired by a statement in the 2015 AAGBI guidelines on monitoring during anaesthesia: the presence of an appropriately trained and experienced anaesthetist is important for patient safety during anaesthesia'. The review starts with a structured description of competence, presenting five dimensions of it; the first two dimensions are identical with the two classical attributes of competence, practical skills and theoretical knowledge. Concerning skills, the value of aiming for a high level of proficiency early in a traning programme is pointed out, and deliberate practice is given as an example of a pedagogical model where aiming for excellence is a core idea. For theoretical knowledge, the value of a deep approach to learning physiology and basic sciences is stressed. The third dimension (anaesthetists' non-technical skills), represents skills necessary for good team-work in the operating theatre. The two last dimensions of competence are the understanding of work and intuitive expert knowing. Understanding work means being aware of what the work is about, appreciating the different aspects of the anaesthetist's job. Intuitive expert knowing, lastly, concerns the tacit dimension of knowledge and skills, which enables professional experts to quickly find a working solution for most clinical problems. The final part of the review is about the when' and how' of competence assessment. The main message is the importance of assessing the competence of clinically active anaesthetists regularly during their whole career.

  • 228.
    Lattuada, Marco
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Effect of Ventilatory Support on Abdominal Fluid Balance in a Sepsis Model2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In patients affected by acute respiratory failure or acute respiratory distress syndrome (ARDS) the leading cause of death is failure of different vital organs other than the lungs, so called multiple organ dysfunction syndrome (MODS). The abdominal organs have a crucial role in the pathogenesis of this syndrome.

    There is a lack of knowledge regarding the mechanisms by which mechanical ventilation can affect the abdominal compartment. One hypothesis is that mechanical ventilation can interfere with abdominal fluid balance causing edema and inflammation.

    We addressed the question whether different levels of ventilatory support (mechanical ventilation with different levels of positive end-expiratory pressure, PEEP, and spontaneous breathing with or without PEEP) can influence abdominal edema and inflammation in both healthy and endotoxin-exposed animals.

    The effect on lymphatic drainage from the abdomen exerted by different degrees of ventilatory support was evaluated (paper I). We demonstrated that endotoxin increases abdominal lymph production, that PEEP and mechanical ventilation increase lymph production but also impede lymphatic drainage; spontaneous breathing improves lymphatic drainage from the abdomen.

    By adapting a non-invasive nuclear medicine imaging technique and validating it (paper II), we have been able to evaluate extravascular fluid accumulation (edema formation) in the abdomen over time (paper III) demonstrating that edema increases during endotoxemia, mimicking a sepsis-like condition, and that spontaneous breathing, compared to mechanical ventilation, reduces extravascular fluid. Pro-inflammatory cytokines TNF-α and IL-6 in intestinal biopsies are reduced during spontaneous breathing compared to mechanical ventilation.

    Abdominal edema results in increased intra-abdominal pressure (IAP): in paper IV we analyzed the effect of increased intra-abdominal pressure on the respiratory system. Pulmonary shunt fraction increased with high IAP both in healthy and LPS animals, resulting in decreased level of oxygenation. These changes are only partially reversible by reducing IAP.

    In conclusion, mechanical ventilation is a life-saving tool but the possible side effect at the extra-pulmonary level should be considered, and the introduction of some degree of spontaneous breathing when clinically possible is a suggested choice.

    Delarbeten
    1. Abdominal lymph flow in an endotoxin sepsis model: Influence of spontaneous breathing and mechanical ventilation
    Öppna denna publikation i ny flik eller fönster >>Abdominal lymph flow in an endotoxin sepsis model: Influence of spontaneous breathing and mechanical ventilation
    2006 (Engelska)Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 34, nr 11, s. 2792-2798Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: Lymph flow from the abdomen was investigated in a sepsis model. We also compared the effect on thoracic duct lymph flow of mechanical ventilation with different levels of positive end-expiratory pressure (PEEP) and spontaneous breathing with continuous positive airway pressure (CPAP). DESIGN: Experimental study. SETTING: Research laboratory in a university hospital. SUBJECTS: Thirty-two pigs. INTERVENTIONS: Animals were anesthetized. In study 1 (n = 18), an ultrasonic flow probe was put around the intact thoracic duct just caudal to the diaphragm, and animals were randomized to receive mechanical ventilation with a PEEP of 5 cm H2O or 15 cm H2O or breathed spontaneously in CPAP with a PEEP of 5 cm H2O. In study 2 (n = 6), the thoracic duct was cannulated and the cannula externalized through the abdominal wall for lymph collection; animals were then ventilated as in study 1. In all animals, endotoxin was infused at 15 μg/kg/hr for 2.5 hrs and then continued at 5 μg/kg/hr. In study 3, healthy (n = 4) and endotoxin-exposed (n = 4) pigs had intra-abdominal pressure increased to 27 cm H2O for 2 hrs by pneumoperitoneum. Lymph flow was measured as in study 1. MEASUREMENTS AND MAIN RESULTS: Lymph flow (mean ± se) was 2.5 ± 0.4 mL/min at baseline and increased to 3.9 ± 0.8 mL/min after 90 mins and 6.3 ± 1.6 mL/min after 150 mins (p < .005) of endotoxin exposure. PEEP 15 cm H2O decreased lymph flow in pigs with intact thoracic duct (flow probe recording) and in pigs with cannulated lymph duct when drained against the central venous pressure. However, when drained against atmospheric pressure, PEEP increased flow. Spontaneous breathing increased flow both in intact and in cannulated animals. CONCLUSIONS: Endotoxin increases lymph flow from the abdomen. Mechanical ventilation with high PEEP impedes lymph drainage and could increase lymph production. Spontaneous breathing increases flow and improves drainage of abdominal edema.

    Nyckelord
    sepsis, lymph, abdomen, positive end-expiratory pressure, mechanical ventilation
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-19586 (URN)10.1097/01.CCM.0000242158.28619.09 (DOI)000241639900012 ()16971857 (PubMedID)
    Tillgänglig från: 2006-11-30 Skapad: 2006-11-30 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
    2. Evaluating abdominal oedema during experimental sepsis using an isotope technique
    Öppna denna publikation i ny flik eller fönster >>Evaluating abdominal oedema during experimental sepsis using an isotope technique
    Visa övriga...
    2012 (Engelska)Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 32, nr 3, s. 197-204Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose: Abdominal oedema is common in sepsis. A technique for the study of such oedema may guide in the fluid regime of these patients.

    Procedures: We modified a double-isotope technique to evaluate abdominal organ oedema and fluid extravasation in 24 healthy or endotoxin-exposed (septic) piglets. Two different markers were used: red blood cells (RBC) labelled with Technetium99m (99mTc) and Transferrin labelled with Indium111 (111In). Images were acquired on a dual-head gamma camera. Microscopic evaluation of tissue biopsies was performed to compare data with the isotope technique.

    Results: No 99mTc activity was measured in the plasma fraction in blood sampled after labelling. Similarly, after molecular size gel chromatography, 111In activity was exclusively found in the high molecular fraction of the plasma. Extravasation of transferrin, indicating the degree of abdominal oedema, was 4 06 times higher in the LPS group compared to the healthy controls (P< 0 0001). Abdominal free fluid, studied in 3 animals, had as high 111In activity as in plasma, but no 99mTc activity. Intestinal lymphatic vessel size was higher in LPS (3 7 +/- 1 1 lm) compared to control animals (0 6 + 0 2 lm; P< 0 001) and oedema correlated to villus diameter (R 2 = 0 918) and lymphatic diameter (R 2 = 0 758). A correlation between a normalized index of oedema formation (NI) and intra-abdominal pressure (IAP) was also found: NI = 0 46* IAP) 3 3 (R2 = 0 56).

    Conclusions: The technique enables almost continuous recording of abdominal oedema formation and may be a valuable tool in experimental research, with the potential to be applied in the clinic.

    Nyckelord
    abdomen, double indicator, gamma camera, microscopy, oedema
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-173971 (URN)10.1111/j.1475-097X.2011.01077.x (DOI)000302545300006 ()
    Tillgänglig från: 2012-05-14 Skapad: 2012-05-09 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
    3. Mechanical ventilation worsens abdominal edema and inflammation in porcine endotoxemia
    Öppna denna publikation i ny flik eller fönster >>Mechanical ventilation worsens abdominal edema and inflammation in porcine endotoxemia
    2013 (Engelska)Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, nr 3, s. R126-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    INTRODUCTION:

    We hypothesized that mechanical ventilation per se increases abdominal edema and inflammation in sepsis and tested this in experimental endotoxemia.

    METHODS:

    Thirty anesthetized piglets were allocated to one of five groups: healthy control pigs breathing spontaneously with continuous positive pressure of 5 cm H2O or mechanically ventilated with positive end-expiratory pressure (PEEP) of 5 cm H2O, and endotoxemic piglets during mechanical ventilation for 2.5 hours and then continued on mechanical ventilation with PEEP of either 5 or 15 cm H2O or switched to spontaneous breathing with continuous positive pressure of 5 cm H2O for another 2.5 hours. Abdominal edema formation was estimated by isotope technique and inflammatory markers were measured in liver, intestine, lung and plasma.

    RESULTS:

    In the healthy controls, 5 hours of spontaneous breathing did not increase abdominal fluid whereas mechanical ventilation did (Normalized Index increased from 1.0 to 1.6;1-3.3 (median and range, p<0.05)). In endotoxemic animals, Normalized Index increased almost six-fold after 5 hours of mechanical ventilation (5.9;4.9-6.9, p<0.05) with two-fold increase from 2.5 to 5 hours whether PEEP was 5 or 15, but only by 40% with spontaneous breathing (p<0.05 vs PEEP of 5 or 15 cm H2O). Tumor Necrosis Factor alpha (TNF-alpha) and interleukin (IL)-6 in intestine and liver were 2-3 times higher with mechanical ventilation than during spontaneous breathing (p<0.05) but similar in plasma and lung. Abdominal edema formation and TNF-alpha in intestine correlated inversely with abdominal perfusion pressure.

    CONCLUSIONS:

    Mechanical ventilation with PEEP increases abdominal edema and inflammation in intestine and liver in experimental endotoxemia by increasing systemic capillary leakage and impeding abdominal lymph drainage.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Anestesiologi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-207180 (URN)10.1186/cc12801 (DOI)000329431100043 ()23799965 (PubMedID)
    Tillgänglig från: 2013-09-10 Skapad: 2013-09-10 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
    4. Effect of increased intra-abdominal pressure (IAP) on lung function in a sepsis model
    Öppna denna publikation i ny flik eller fönster >>Effect of increased intra-abdominal pressure (IAP) on lung function in a sepsis model
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    We have previously shown that mechanical ventilation with positive pressure increases abdominal edema formation and causes an increase in intra-abdominal pressure (IAP) in a sepsis-like porcine model. In this study we investigated, in the same animal model effects of increase in IAP on the cardiovascular and respiratory system. Twelve pigs of Swedish country breed with a mean weight 28 kg were anesthetized and mechanically ventilated. Six animals received a continuous infusion of endotoxin and the other six served as controls. Catheters were inserted for vascular pressure recordings and cardiac output was measured by thermo-dilution. In both groups IAP was temporarily elevated to 20 mmHg by insufflation of CO2 into the abdominal cavity. Endotoxin infusion caused significant increases in pulmonary artery and central venous pressures and increase in shunt with fall in PaO2. Respiratory compliance was reduced. IAP elevation by CO2 insufflation increased these pressures as well as shunt further and caused additional decrease in compliance. Deflation of the abdomen returned vascular pressures to pre-insufflation but shunt remained increased and PaO2 was still reduced as was compliance. In control animals similar but smaller changes were seen on increase in IAP but with deflation not only vascular pressures but also shunt and PaO2 returned to normal. This suggests that in the sepsis-like condition, increased IAP causes persisting deterioration of lung function even when IAP has been normalized. We propose this to be caused by lung collapse that remains, at least for some time, after deflation.

    Nyckelord
    intra-abdominal pressure, IAP, pneumoperitoneum, shunt, MIGET, sepsis
    Nationell ämneskategori
    Anestesi och intensivvård Fysiologi
    Forskningsämne
    Anestesiologi och intensivvård; Klinisk fysiologi
    Identifikatorer
    urn:nbn:se:uu:diva-207402 (URN)
    Tillgänglig från: 2013-09-13 Skapad: 2013-09-13 Senast uppdaterad: 2018-05-31
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  • 229.
    Lattuada, Marco
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Fredén, Filip
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Reinius, Henrik
    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.
    Effect of increased intra-abdominal pressure (IAP) on lung function in a sepsis modelManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    We have previously shown that mechanical ventilation with positive pressure increases abdominal edema formation and causes an increase in intra-abdominal pressure (IAP) in a sepsis-like porcine model. In this study we investigated, in the same animal model effects of increase in IAP on the cardiovascular and respiratory system. Twelve pigs of Swedish country breed with a mean weight 28 kg were anesthetized and mechanically ventilated. Six animals received a continuous infusion of endotoxin and the other six served as controls. Catheters were inserted for vascular pressure recordings and cardiac output was measured by thermo-dilution. In both groups IAP was temporarily elevated to 20 mmHg by insufflation of CO2 into the abdominal cavity. Endotoxin infusion caused significant increases in pulmonary artery and central venous pressures and increase in shunt with fall in PaO2. Respiratory compliance was reduced. IAP elevation by CO2 insufflation increased these pressures as well as shunt further and caused additional decrease in compliance. Deflation of the abdomen returned vascular pressures to pre-insufflation but shunt remained increased and PaO2 was still reduced as was compliance. In control animals similar but smaller changes were seen on increase in IAP but with deflation not only vascular pressures but also shunt and PaO2 returned to normal. This suggests that in the sepsis-like condition, increased IAP causes persisting deterioration of lung function even when IAP has been normalized. We propose this to be caused by lung collapse that remains, at least for some time, after deflation.

  • 230. Li, Qinghu
    et al.
    Dong, Jinlei
    Yang, Yongliang
    Wang, Guodong
    Wang, Yonghui
    Liu, Ping
    Robinson, Yohan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Zhou, Dongsheng
    Retroperitoneal packing or angioembolization for haemorrhage control of pelvic fractures-Quasi-randomized clinical trial of 56 haemodynamically unstable patients with Injury Severity Score ≥332016Ingår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 47, nr 2, s. 395-401Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Both retroperitoneal pelvic packing and primary angioembolization are widely used to control haemorrhage related to pelvic fractures. It is still unknown which protocol is the safest. The primary aim of this study is to compare survival and complications of pelvic packing and angioembolization in massive haemorrhage related to pelvic fractures.

    METHODS: Patients with haemodynamically unstable pelvic fractures were quasi-randomized to either pelvic packing (PACK) or angiography (ANGIO) using the time of admission as separator. Physiological markers of haemorrhage, time to intervention, procedure/surgical time, transfusion requirements, complications and early mortality were recorded and analyzed.

    RESULTS: 29 patients were randomized to PACK and 27 patients to ANGIO. The Injury Severity Score (ISS) in the ANGIO group was lower than in the PACK group (43±7 vs 48±6) (p<0.01). The median time from admission to angiography for the ANGIO group was 102min (range 76-214), and longer than 77min (range 43-125) from admission to surgery for the PACK group (p<0.01). The procedure time for the ANGIO group was 84min (range 62-105); while the surgical time was 60min (range 41-92) for the PACK group (p<0.001). The ANGIO group received 6.4 units packed red blood cells (range 4-10) in the first 24h after angiography. The PACK group required 5.2 units (range 3-10) in the first 24h after leaving the operating theatre (p=0.124). 9 patients in the ANGIO group underwent pelvic packing for persistent bleeding. 6 patients in the PACK group required pelvic angiography after pelvic packing for ongoing hypotension following packing (p=0.353). 5 patients in the ANGIO group died (2 from exsanguination), while 4 in the PACK group died (none from exsanguination) (p=0.449). Complications occurred without differences in both groups.

    CONCLUSIONS: Compared with angioembolization, pelvic packing has shorter time to intervention and surgical time. Thus pelvic packing is the more rapid treatment of severe pelvic trauma than pelvic angioembolization. It is suitable for patients with haemodynamic instability at centers where the interventional radiology staff is not in-house at all times.

    REGISTRATION: ClinicalTrials.gov (NCT02535624) and ISRCTN registry (ISRCTN91713422).

  • 231. Li, Y.
    et al.
    Tesselaar, E.
    Borges, João Batista
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Bohm, S. H.
    Sjoberg, F.
    Janerot-Sjoberg, B.
    Hyperoxia affects the regional pulmonary ventilation/perfusion ratio: an electrical impedance tomography study2014Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, nr 6, s. 716-725Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The way in which hyperoxia affects pulmonary ventilation and perfusion is not fully understood. We investigated how an increase in oxygen partial pressure in healthy young volunteers affects pulmonary ventilation and perfusion measured by thoracic electrical impedance tomography (EIT). Methods Twelve semi-supine healthy male volunteers aged 21-36 years were studied while breathing room air and air-oxygen mixtures (FiO2) that resulted in predetermined transcutaneous oxygen partial pressures (tcPO2) of 20, 40 and 60kPa. The magnitude of ventilation (Zv) and perfusion (ZQ)-related changes in cyclic impedance variations, were determined using an EIT prototype equipped with 32 electrodes around the thorax. Regional changes in ventral and dorsal right lung ventilation (V) and perfusion (Q) were estimated, and V/Q ratios calculated. Results There were no significant changes in Zv with increasing tcPO2 levels. ZQ in the dorsal lung increased with increasing tcPO2 (P=0.01), whereas no such change was seen in the ventral lung. There was a simultaneous decrease in V/Q ratio in the dorsal region during hyperoxia (P=0.04). Two subjects did not reach a tcPO2 of 60kPa despite breathing 100% oxygen. Conclusion These results indicate that breathing increased concentrations of oxygen induces pulmonary vasodilatation in the dorsal lung even at small increases in FiO2. Ventilation remains unchanged. Local mismatch of ventilation and perfusion occurs in young healthy men, and the change in ventilation/perfusion ratio can be determined non-invasively by EIT.

  • 232.
    Lind, Anne-Li
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Biomarkers for Better Understanding of the Pathophysiology and Treatment of Chronic Pain: Investigations of Human Biofluids2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Chronic pain affects 20 % of the global population, causes suffering, is difficult to treat, and constitutes a large economic burden for society. So far, the characterization of molecular mechanisms of chronic pain-like behaviors in animal models has not translated into effective treatments.

    In this thesis, consisting of five studies, pain patient biofluids were analyzed with modern proteomic methods to identify biomarker candidates that can be used to improve our understanding of the pathophysiology chronic pain and lead to more effective treatments.

    Paper I is a proof of concept study, where a multiplex solid phase-proximity ligation assay (SP-PLA) was applied to cerebrospinal fluid (CSF) for the first time. CSF reference protein levels and four biomarker candidates for ALS were presented. The investigated proteins were not altered by spinal cord stimulation (SCS) treatment for neuropathic pain. In Paper II, patient CSF was explored by dimethyl and label-free mass spectrometric (MS) proteomic methods. Twelve proteins, known for their roles in neuroprotection, nociceptive signaling, immune regulation, and synaptic plasticity, were identified to be associated with SCS treatment of neuropathic pain. In Paper III, proximity extension assay (PEA) was used to analyze levels of 92 proteins in serum from patients one year after painful disc herniation. Patients with residual pain had significantly higher serum levels of 41 inflammatory proteins. In Paper IV, levels of 55 proteins were analyzed by a 100-plex antibody suspension bead array (ASBA) in CSF samples from two neuropathic pain patient cohorts, one cohort of fibromyalgia patients and two control cohorts. CSF protein profiles consisting of levels of apolipoprotein C1, ectonucleotide pyrophosphatase/phosphodiesterase family member 2, angiotensinogen, prostaglandin-H2 D-isomerase, neurexin-1, superoxide dismutases 1 and 3 were found to be associated with neuropathic pain and fibromyalgia. In Paper V, higher CSF levels of five chemokines and LAPTGF-beta-1were detected in two patient cohorts with neuropathic pain compared with healthy controls.

    In conclusion, we demonstrate that combining MS proteomic and multiplex antibody-based methods for analysis of patient biofluid samples is a viable approach for discovery of biomarker candidates for the pathophysiology and treatment of chronic pain. Several biomarker candidates possibly reflecting systemic inflammation, lipid metabolism, and neuroinflammation in different pain conditions were identified for further investigation.

    Delarbeten
    1. A Multiplex Protein Panel Applied to Cerebrospinal Fluid Reveals Three New Biomarker Candidates in ALS but None in Neuropathic Pain Patients
    Öppna denna publikation i ny flik eller fönster >>A Multiplex Protein Panel Applied to Cerebrospinal Fluid Reveals Three New Biomarker Candidates in ALS but None in Neuropathic Pain Patients
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    2016 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 2, artikel-id e0149821Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The objective of this study was to develop and apply a novel multiplex panel of solid-phase proximity ligation assays (SP-PLA) requiring only 20 μL of samples, as a tool for discovering protein biomarkers for neurological disease and treatment thereof in cerebrospinal fluid (CSF). We applied the SP-PLA to samples from two sets of patients with poorly understood nervous system pathologies amyotrophic lateral sclerosis (ALS) and neuropathic pain, where patients were treated with spinal cord stimulation (SCS). Forty-seven inflammatory and neurotrophic proteins were measured in samples from 20 ALS patients and 15 neuropathic pain patients, and compared to normal concentrations in CSF from control individuals. Nineteen of the 47 proteins were detectable in more than 95% of the 72 controls. None of the 21 proteins detectable in CSF from neuropathic pain patients were significantly altered by SCS. The levels of the three proteins, follistatin, interleukin-1 alpha, and kallikrein-5 were all significantly reduced in the ALS group compared to age-matched controls. These results demonstrate the utility of purpose designed multiplex SP-PLA panels in CSF biomarker research for understanding neuropathological and neurotherapeutic mechanisms. The protein changes found in the CSF of ALS patients may be of diagnostic interest.

    Nationell ämneskategori
    Neurologi Teknik och teknologier
    Identifikatorer
    urn:nbn:se:uu:diva-281233 (URN)10.1371/journal.pone.0149821 (DOI)000371175700030 ()26914813 (PubMedID)
    Forskningsfinansiär
    VetenskapsrådetKnut och Alice Wallenbergs StiftelseEU, Europeiska forskningsrådet, 316929EU, Europeiska forskningsrådet, 294409
    Tillgänglig från: 2016-03-21 Skapad: 2016-03-21 Senast uppdaterad: 2017-11-30Bibliografiskt granskad
    2. Spinal Cord Stimulation Alters Protein Levels in the Cerebrospinal Fluid of Neuropathic Pain Patients: A Proteomic Mass Spectrometric Analysis
    Öppna denna publikation i ny flik eller fönster >>Spinal Cord Stimulation Alters Protein Levels in the Cerebrospinal Fluid of Neuropathic Pain Patients: A Proteomic Mass Spectrometric Analysis
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    2016 (Engelska)Ingår i: Neuromodulation (Malden, Mass.), ISSN 1094-7159, E-ISSN 1525-1403, Vol. 19, nr 6, s. 549-562Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    ObjectivesElectrical neuromodulation by spinal cord stimulation (SCS) is a well-established method for treatment of neuropathic pain. However, the mechanism behind the pain relieving effect in patients remains largely unknown. In this study, we target the human cerebrospinal fluid (CSF) proteome, a little investigated aspect of SCS mechanism of action. MethodsTwo different proteomic mass spectrometry protocols were used to analyze the CSF of 14 SCS responsive neuropathic pain patients. Each patient acted as his or her own control and protein content was compared when the stimulator was turned off for 48 hours, and after the stimulator had been used as normal for three weeks. ResultsEighty-six proteins were statistically significantly altered in the CSF of neuropathic pain patients using SCS, when comparing the stimulator off condition to the stimulator on condition. The top 12 of the altered proteins are involved in neuroprotection (clusterin, gelsolin, mimecan, angiotensinogen, secretogranin-1, amyloid beta A4 protein), synaptic plasticity/learning/memory (gelsolin, apolipoprotein C1, apolipoprotein E, contactin-1, neural cell adhesion molecule L1-like protein), nociceptive signaling (neurosecretory protein VGF), and immune regulation (dickkopf-related protein 3). ConclusionPreviously unknown effects of SCS on levels of proteins involved in neuroprotection, nociceptive signaling, immune regulation, and synaptic plasticity are demonstrated. These findings, in the CSF of neuropathic pain patients, expand the picture of SCS effects on the neurochemical environment of the human spinal cord. An improved understanding of SCS mechanism may lead to new tracks of investigation and improved treatment strategies for neuropathic pain.

    Nyckelord
    Cerebrospinal fluid, mechanism of action, neuropathic pain, spinal cord stimulation
    Nationell ämneskategori
    Neurologi Radiologi och bildbehandling
    Identifikatorer
    urn:nbn:se:uu:diva-304434 (URN)10.1111/ner.12473 (DOI)000382755300001 ()27513633 (PubMedID)
    Forskningsfinansiär
    VINNOVAVetenskapsrådet
    Tillgänglig från: 2016-10-05 Skapad: 2016-10-05 Senast uppdaterad: 2019-04-29Bibliografiskt granskad
    3. Inflammatory Serum Protein Profiling of Patients with Lumbar Radicular Pain One Year after Disc Herniation
    Öppna denna publikation i ny flik eller fönster >>Inflammatory Serum Protein Profiling of Patients with Lumbar Radicular Pain One Year after Disc Herniation
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    2016 (Engelska)Ingår i: INTERNATIONAL JOURNAL OF INFLAMMATION, ISSN 2090-8040, artikel-id UNSP 3874964Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Earlier studies suggest that lumbar radicular pain following disc herniation may be associated with a local or systemic inflammatory process. In the present study, we investigated the serum inflammatory protein profile of such patients. All 45 patients were recruited from Oslo University Hospital, Ulleval, Norway, during the period 2007-2009. The new multiplex proximity extension assay (PEA) technology was used to analyze the levels of 92 proteins. Interestingly, the present data showed that patients with radicular pain 12 months after disc herniation may be different from other patients with regard to many measurable serum cytokines. Given a false discovery rate (FDR) of 0.10 and 0.05, we identified 41 and 13 proteins, respectively, which were significantly upregulated in the patients with severe pain one year after disc herniation. On the top of the list ranked by estimated increase we found C-X-C motif chemokine 5 (CXCM5; 217% increase), epidermal growth factor (EGF; 142% increase), and monocyte chemotactic protein 4 (MCP-4; 70% increase). Moreover, a clear overall difference in the serum cytokine profile between the chronic and the recovered patients was demonstrated. Thus, the present results may be important for future protein serum profiling of lumbar radicular pain patients with regard to prognosis and choice of treatment. We conclude that serum proteins may be measurable molecular markers of persistent pain after disc herniation.

    Nationell ämneskategori
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-317717 (URN)10.1155/2016/3874964 (DOI)000394106300001 ()27293953 (PubMedID)
    Forskningsfinansiär
    VINNOVAVetenskapsrådet, P29797-1
    Tillgänglig från: 2017-03-17 Skapad: 2017-03-17 Senast uppdaterad: 2018-01-13Bibliografiskt granskad
    4. Affinity Proteomics Applied to Patient CSF Identifies Protein Profiles Associated with Neuropathic Pain and Fibromyalgia
    Öppna denna publikation i ny flik eller fönster >>Affinity Proteomics Applied to Patient CSF Identifies Protein Profiles Associated with Neuropathic Pain and Fibromyalgia
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    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: Today, there are no biological tests on which to base pain diagnoses, treatment choices or to understand the biological processes underlying and accompanying chronic pain for the individual pain patient. Relevant biological markers would greatly aid in diagnosis and treatment of patients with chronic pain. Our study aimed to find proteins in CSF associated with fibromyalgia and neuropathic pain, two common and poorly understood chronic pain conditions.

    Methods: We have performed CSF protein profiling of 55 proteins using a 100-plex antibody suspension bead array. We collected, analyzed and compared CSF samples from 25 patients with neuropathic pain (two independent sets, n=14 patients for discovery and n=11 for verification), 40 patients with fibromyalgia and 135 controls without neurological disease from two different populations.

    Results: We found significant differences in CSF protein levels between patients and controls (p<0.05). Among these proteins, Apolipoprotein C1 (APOC1) was found to be increased in CSF of neuropathic pain patients compared to controls and there was a non-significant trend for increased levels also in fibromyalgia patient CSF. Ectonucleotide pyrophosphatase (ENPP2, Autotaxin) was increased in the CSF of fibromyalgia patients compared to all other groups including neuropathic pain patients.  Multivariate analysis revealed partially overlapping and partially distinct CSF profiles in neuropathic pain patients compared with fibromyalgia and controls for several other proteins including angiotensinogen (AGT), prostaglandin-H2 D-isomerase (PTGDS), neurexin-1 (NRXN1), superoxide dismutase 1 (SOD1) and superoxide dismutase 3 (SOD3).

    Conclusions: Our results, suggest that the CSF protein profiles of neuropathic pain and fibromyalgia patients may be different from each other and from those of controls. CSF levels of APOC1, ENPP2, AGT, PTGDS, NRXN1, SOD1 and SOD3 should be further investigated for their potential to serve as biomarkers of different kinds of pain pathophysiology.

    Nyckelord
    cerebrospinal fluid, biomarker, human, chronic pain, neuropathic pain, fibromyalgia, spinal cord stimulation, mechanism of action, radiculopathy, protein, inflammation, neuroinflammation, mass spectrometry, antibody suspension bead array, protein profiling
    Nationell ämneskategori
    Neurovetenskaper Klinisk laboratoriemedicin Hälsovetenskaper Anestesi och intensivvård Biomedicinsk laboratorievetenskap/teknologi
    Forskningsämne
    Anestesiologi och intensivvård; Bioinformatik; Biokemi; Biologi med inriktning mot molekylärbiologi; Biomedicinsk laboratorievetenskap; Kemi med inriktning mot analytisk kemi; Klinisk kemi; Medicinsk vetenskap; Molekylär medicin
    Identifikatorer
    urn:nbn:se:uu:diva-326158 (URN)
    Projekt
    Berzelii Technology Centre of Neurodiagnostics
    Forskningsfinansiär
    AFA Försäkring, 140341VINNOVAVetenskapsrådet
    Tillgänglig från: 2017-07-03 Skapad: 2017-07-03 Senast uppdaterad: 2018-01-13
    5. High Levels of Cerebrospinal Fluid Chemokines Point to the Presence of Neuroinflammation in Peripheral Neuropathic Pain: A Cross-Sectional Study of Two Cohorts of Patients Compared to Healthy Controls
    Öppna denna publikation i ny flik eller fönster >>High Levels of Cerebrospinal Fluid Chemokines Point to the Presence of Neuroinflammation in Peripheral Neuropathic Pain: A Cross-Sectional Study of Two Cohorts of Patients Compared to Healthy Controls
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    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Animal models suggest that chemokines are important mediators in the pathophysiology of neuropathic pain. Indeed, these substances have been called “gliotransmitters”, a term that illustrates the close interplay between glial cells and neurons in the context of neuroinflammation and pain. However, evidence in humans is scarce. The aim of the study was to determine a comprehensive cerebrospinal fluid (CSF) inflammatory profile for neuropathic pain patients. Our hypothesis was that we would thereby find indications of a postulated on-going process of central neuroinflammation.  

    CSF samples were collected from two cohorts of patients with neuropathic pain (n=11 and n=16, respectively) and healthy controls (n=11). The samples were analyzed with a multiplex proximity extension assay in which 92 inflammation-related proteins were measured simultaneously (Proseek® Multiplex Inflammation I, Olink Bioscience, Uppsala, Sweden). Univariate testing with control of false discovery rate, as well as orthogonal partial least squares – discriminant analysis, were used for statistical analyses.

    CSF levels of chemokines CXCL6, CXCL10, CCL8, CCL11, CCL23, as well as protein LAPTGF-beta-1, were significantly higher in both neuropathic pain cohorts compared to healthy controls, pointing to neuroinflammation in patients. These 6 proteins were also major results in a recent similar study in fibromyalgia patients. The findings need to be confirmed in larger cohorts, and the question of causality remains to be settled. Since it has been suggested that prevalent co-morbidities to chronic pain (e.g., depression, anxiety, poor sleep, and tiredness) also are associated with inflammation, it will be important to determine whether inflammation is a common mediator.

    Nyckelord
    biomarker; cerebrospinal fluid; chemokines; cytokines; human; inflammation; neuroinflammation; neuropathic pain; protein profile; proximity extension assay (PEA), chronic pain
    Nationell ämneskategori
    Anestesi och intensivvård Klinisk laboratoriemedicin Biomedicinsk laboratorievetenskap/teknologi Neurovetenskaper Medicinsk laboratorie- och mätteknik
    Forskningsämne
    Anestesiologi och intensivvård; Biomedicinsk laboratorievetenskap; Kemi med inriktning mot analytisk kemi; Medicinsk vetenskap; Medicinsk biokemi; Molekylär medicin
    Identifikatorer
    urn:nbn:se:uu:diva-326161 (URN)
    Projekt
    Uppsala Berzelii Technology Centre for NeurodiagnosticsAFA Insurance (140341)Swedish Research Council (grant no. K2015-99x-21874-05-4)the Swedish Research Council (grant no. P29797-1).Swedish Governmental Agency for Innovation Systems (Vinnova)County Council of Östergötland (LIO-35923, SC-2013-00395-36)
    Forskningsfinansiär
    AFA Försäkring, 140341VINNOVA, P29797-1Vetenskapsrådet, P29797-1Vetenskapsrådet, K2015-99x-21874-05-4
    Tillgänglig från: 2017-07-03 Skapad: 2017-07-03 Senast uppdaterad: 2018-01-13
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  • 233.
    Lind, Anne-Li
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Just, David
    SciLifeLab, School of Biotechnology, KTH – Royal Institute of Technology, Stockholm, Sweden.
    Mikus, Maria
    SciLifeLab, School of Biotechnology, KTH – Royal Institute of Technology, Stockholm, Sweden.
    Fredolini, Claudia
    SciLifeLab, School of Biotechnology, KTH – Royal Institute of Technology, Stockholm, Sweden.
    Ioannou, Marina
    SciLifeLab, School of Biotechnology, KTH – Royal Institute of Technology, Stockholm, Sweden.
    Gerdle, Björn
    Linköping University, Linköping, Sweden.
    Bäckryd, Emmanuel
    Linköping University, Linköping, Sweden.
    Tanum, Lars
    Akershus University Hospital, Lørenskog, Norway.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Nilsson, Peter
    SciLifeLab, School of Biotechnology, KTH – Royal Institute of Technology, Stockholm, Sweden.
    Månberg, Anna
    SciLifeLab, School of Biotechnology, KTH – Royal Institute of Technology, Stockholm, Sweden.
    Affinity Proteomics Applied to Patient CSF Identifies Protein Profiles Associated with Neuropathic Pain and FibromyalgiaManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: Today, there are no biological tests on which to base pain diagnoses, treatment choices or to understand the biological processes underlying and accompanying chronic pain for the individual pain patient. Relevant biological markers would greatly aid in diagnosis and treatment of patients with chronic pain. Our study aimed to find proteins in CSF associated with fibromyalgia and neuropathic pain, two common and poorly understood chronic pain conditions.

    Methods: We have performed CSF protein profiling of 55 proteins using a 100-plex antibody suspension bead array. We collected, analyzed and compared CSF samples from 25 patients with neuropathic pain (two independent sets, n=14 patients for discovery and n=11 for verification), 40 patients with fibromyalgia and 135 controls without neurological disease from two different populations.

    Results: We found significant differences in CSF protein levels between patients and controls (p<0.05). Among these proteins, Apolipoprotein C1 (APOC1) was found to be increased in CSF of neuropathic pain patients compared to controls and there was a non-significant trend for increased levels also in fibromyalgia patient CSF. Ectonucleotide pyrophosphatase (ENPP2, Autotaxin) was increased in the CSF of fibromyalgia patients compared to all other groups including neuropathic pain patients.  Multivariate analysis revealed partially overlapping and partially distinct CSF profiles in neuropathic pain patients compared with fibromyalgia and controls for several other proteins including angiotensinogen (AGT), prostaglandin-H2 D-isomerase (PTGDS), neurexin-1 (NRXN1), superoxide dismutase 1 (SOD1) and superoxide dismutase 3 (SOD3).

    Conclusions: Our results, suggest that the CSF protein profiles of neuropathic pain and fibromyalgia patients may be different from each other and from those of controls. CSF levels of APOC1, ENPP2, AGT, PTGDS, NRXN1, SOD1 and SOD3 should be further investigated for their potential to serve as biomarkers of different kinds of pain pathophysiology.

  • 234.
    Linder, Fredrik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Mani, Kevin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Juhlin, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Eklöf, Hampus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Routine whole body CT of high energy trauma patients leads to excessive radiation exposure2016Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Whole body computed tomography (WBCT) is an important adjunct in trauma care, which is often part of standard protocol in initial management of trauma patients. However, WBCT exposes patients to a significant dose of radiation. The use of WBCT was assessed in a modern trauma cohort in Sweden.

    METHODS: A two-center retrospective cohort study was performed. All consecutive trauma alert patients at a university hospital (July-December 2008), and a rural county hospital (January 2009- December 2010) were included. Patients were stratified into three groups (high, intermediate and low risk) based on documented suspected injuries at primary survey at the site of accident or at the emergency department. Injury severity score (ISS) was calculated. Case records were reviewed for clinical and radiological findings at the time of trauma, and during a ≥36 months of follow-up period to identify possible missed injuries.

    RESULTS: A total of 523 patients were included in the study (university hospital n = 273; rural county hospital n = 250), out of which 475 patients (91.0 %) underwent radiological examinations, 290 patients (55.4 %) underwent WBCT, which identified trauma related findings in 125 patients (43.1 % of those examined). The high-risk group (n = 62) had a mean age of 38.5 years (21.1 SD). Mean ISS was 16.48 (18.14 SD). In this group, WBCT resulted in a positive finding in 38 (74.5 %) patients. In the intermediate-risk group (n = 322; mean age 37.66, 20.24 SD) ISS was 4.42 (6.30 SD). A positive finding on WBCT was found in 87 of the intermediate group patients (44.8 %). The low-risk group (n = 139; mean age 32.5 years; 21.4 SD) had a mean ISS of 0.84 (1.57 SD) with no positive findings on WBCT and no missed injuries in medical records at ≥36 months.

    DISCUSSION: The risk of developing radiation induced cancer is significant for young people if exposed to relatively high dose radiation as is the case in WBCT. WBCT in high-energy trauma is important for planning of treatment in severely injured patients while it can be questioned in the seemingly not injured where it is used mainly to permit early discharge from the ED.

    CONCLUSIONS: Risk stratification criteria could in this retrospective study identify high energy trauma patients not in need of radiological imaging. WBCT in high-energy trauma does not affect patient care if the patient is mentally alert, not intoxicated nor shows signs of other than minor injuries when evaluated by a trauma-team. The risk of missing important traumatic findings in these patients is very low. Observation of the patient with reexamination instead of imaging may be considered in this group of often young patients where radiation dose is an issue.

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  • 235.
    Lindgren, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    A study comparing victims of out-of-hospital and in-hospital cardiac arrest admitted alive to the ICU.Manuskript (preprint) (Övrigt vetenskapligt)
  • 236.
    Lindgren, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Cardiac Arrest – mechanical chest compressions, gender differences and coronary angiography2020Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Cardiac arrest is a major health problem with over 6000 cases of out-of-hospital cardiac arrest (OHCA) and 2500 cases of in-hospital cardiac arrest (IHCA) per year in Sweden. Survival are low. Many factors affect the chances of survival, including effective cardiopulmonary resuscitation and optimal post resuscitation care. These thesis involve these areas. Paper I+II describe a randomized clinical trial (n=2589). We compared a novel CPR algorithm with defibrillations during ongoing chest compressions delivered with a mechanical chest compression device and manual CPR according to guidelines. We found no difference in 4-hour survival, 23.6% with mechanical CPR and 23.7% with manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. Paper III is a registry study (n=1498). We investigated impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome among OHCA victims with an initially shockable rhythm. We found no difference between men and women in rates of ST-elevation/left bundle branch block (LBBB), 40% vs. 38% or rates of CAG, 45% vs. 40%. Among patients without ST-elevation/LBBB more men than women had CAG followed by PCI, 59% vs. 42% (P=0.03) and more advanced coronary artery disease. We found no association between gender and use of early CAG. Paper IV is a retrospective observational single centre study (n=423) of ICU treated victims of cardiac arrest. OHCA and IHCA were compared regarding comorbidity, characteristics of the arrest, treatment including CAG and CAG findings and outcome. OHCA patients had less preexisting comorbidity, lower rates of bystander CPR 71% vs 100% (p<0.001) and longer time to return of spontaneous circulation, 20 vs 10 minutes (p<0.001). OHCA patients more often had a shockable first rhythm, 47% vs 13% (p<0.001) and CA without any obvious non-cardiac origin, 77% vs 50% (p<0.001). OHCA patients more often underwent early CAG, 52% vs 25% (p<0.001) but no difference in rates of subsequent PCI or angiogram with at least one significant stenosis was seen. OHCA and IHCA did not differ in 30-days survival, 42% vs 41% or 1-year survival, 39% vs 33% 

    Delarbeten
    1. The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation
    Öppna denna publikation i ny flik eller fönster >>The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation
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    2013 (Engelska)Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, s. 5-Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: The LUCAS (TM) device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS (TM) device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials. gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). Results: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS (TM) device when used in association with defibrillation during on-going CPR.

    Nyckelord
    Cardiac arrest, Mechanical chest compression, Defibrillation, External chest compressions, Ventricular fibrillation, Asystole, Pulseless electrical activity
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-197667 (URN)10.1186/1757-7241-21-5 (DOI)000315588600001 ()
    Tillgänglig från: 2013-04-02 Skapad: 2013-04-02 Senast uppdaterad: 2020-01-16Bibliografiskt granskad
    2. Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest The LINC Randomized Trial
    Öppna denna publikation i ny flik eller fönster >>Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest The LINC Randomized Trial
    Visa övriga...
    2014 (Engelska)Ingår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 311, nr 1, s. 53-61Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    IMPORTANCE A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. OBJECTIVE To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. INTERVENTIONS Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). MAIN OUTCOMES AND MEASURES Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. RESULTS Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. CONCLUSIONS AND RELEVANCE Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-216731 (URN)10.1001/jama.2013.282538 (DOI)000329161400018 ()
    Tillgänglig från: 2014-01-27 Skapad: 2014-01-24 Senast uppdaterad: 2020-01-16Bibliografiskt granskad
    3. Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study
    Öppna denna publikation i ny flik eller fönster >>Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study
    Visa övriga...
    2019 (Engelska)Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, s. 189-195Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction: We investigated the impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome in a large population of out-of-hospital cardiac arrest (OHCA) patients with an initially shockable rhythm.

    Methods: Retrospective cohort study. Data retrieved 2008-2013 from the Swedish Register for Cardio-Pulmonary Resuscitation, Swedeheart Registry and National Patient Register.

    Results: We identified 1498 patients of whom 78% were men. Men and women had the same pathology on the first registered electrocardiogram (ECG): 30% vs. 29% had ST-elevation and 10% vs. 9% had left bundle branch block (LBBB) (P=0.97). Proportions of performed CAG did not differ between genders. Among patients without ST-elevation/LBBB men more often had at least one significant stenosis, 78% vs. 54% (P= 0.001), more multi-vessel disease (P= 0.01), had normal coronary angiography less often, 22% vs. 46% and PCI more often, 59% vs. 42% (P= 0.03). Among patients without STelevation/LBBB on the initial ECG, more men had previously known ischaemic heart disease, 27% vs. 19% (P=0.02) and a presumed cardiac origin of the cardiac arrest, 86% vs. 72% (P< 0.001). Multivariable analysis showed no association between gender and evaluation by early CAG. In men and women, 1-year survival was 56% vs. 50% (P= 0.22) in patients with ST-elevation/LBBB and 48% vs. 51% (P= 0.50) in patients without.

    Conclusion: Despite no gender differences in ECG findings indicating an early CAG, men had more severe coronary artery disease while women more frequently had normal coronary angiography. However, this did not influence 1-year survival.

    Nyckelord
    Cardiac arrest, Gender differences, Out-of-hospital cardiac arrest, Coronary angiography, Percutaneous coronary intervention, Ventricular fibrillation, CPR, Registry study
    Nationell ämneskategori
    Kardiologi Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:uu:diva-395786 (URN)10.1016/j.resuscitation.2019.07.015 (DOI)000487197500028 ()31330199 (PubMedID)
    Tillgänglig från: 2019-10-28 Skapad: 2019-10-28 Senast uppdaterad: 2020-01-16Bibliografiskt granskad
    4. A study comparing victims of out-of-hospital and in-hospital cardiac arrest admitted alive to the ICU.
    Öppna denna publikation i ny flik eller fönster >>A study comparing victims of out-of-hospital and in-hospital cardiac arrest admitted alive to the ICU.
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nyckelord
    Cardiac arrest, OHCA, IHCA, CPR, coronary angiography, percutaneous coronary intervention, PCI
    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Internmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-402517 (URN)
    Tillgänglig från: 2020-01-16 Skapad: 2020-01-16 Senast uppdaterad: 2020-01-16
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  • 237.
    Lindgren, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Covaciu, Lucian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Smekal, David
    Uppsala Ctr Prehosp Res, Uppsala, Sweden.
    Lagedal, Rickard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nordberg, Per
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Stockholm, Sweden.
    Elfwen, Ludvig
    Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, Stockholm, Sweden.
    Svensson, Leif
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Stockholm, Sweden.
    Jonsson, Martin
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Stockholm, Sweden.
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study2019Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 143, s. 189-195Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: We investigated the impact of gender in performance and findings of early coronary angiography (CAG) and percutaneous coronary intervention (PCI), comorbidity and outcome in a large population of out-of-hospital cardiac arrest (OHCA) patients with an initially shockable rhythm.

    Methods: Retrospective cohort study. Data retrieved 2008-2013 from the Swedish Register for Cardio-Pulmonary Resuscitation, Swedeheart Registry and National Patient Register.

    Results: We identified 1498 patients of whom 78% were men. Men and women had the same pathology on the first registered electrocardiogram (ECG): 30% vs. 29% had ST-elevation and 10% vs. 9% had left bundle branch block (LBBB) (P=0.97). Proportions of performed CAG did not differ between genders. Among patients without ST-elevation/LBBB men more often had at least one significant stenosis, 78% vs. 54% (P= 0.001), more multi-vessel disease (P= 0.01), had normal coronary angiography less often, 22% vs. 46% and PCI more often, 59% vs. 42% (P= 0.03). Among patients without STelevation/LBBB on the initial ECG, more men had previously known ischaemic heart disease, 27% vs. 19% (P=0.02) and a presumed cardiac origin of the cardiac arrest, 86% vs. 72% (P< 0.001). Multivariable analysis showed no association between gender and evaluation by early CAG. In men and women, 1-year survival was 56% vs. 50% (P= 0.22) in patients with ST-elevation/LBBB and 48% vs. 51% (P= 0.50) in patients without.

    Conclusion: Despite no gender differences in ECG findings indicating an early CAG, men had more severe coronary artery disease while women more frequently had normal coronary angiography. However, this did not influence 1-year survival.

  • 238.
    Lindgren, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Reply to letter: What is the meaning of "early CAG"?2020Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 146, s. 287-287Artikel i tidskrift (Övrigt vetenskapligt)
  • 239. Lindgren, S
    et al.
    Pikwer, A
    Ricksten, S-E
    Åkeson, J
    Survey of central venous catheterisation practice in Sweden.2013Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, nr 10, s. 1237-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Clinical guidelines on central venous catheterisation were introduced by the Swedish Society of Anaesthesiology and Intensive Care Medicine in 2011. The purpose of this study was to investigate current national practice and assess to what extent these guidelines influence clinical routines in Swedish operating wards and intensive care units.

    METHODS: An invitation to participate in an online survey regarding central venous catheterisation was sent to 65 departments of anaesthesiology and intensive care medicine in Sweden. The survey aimed at investigating routine standards (part 1) and 24-h clinical practice (part 2).

    RESULTS: Forty-seven (72%) and 49 (75%) of 65 departments took part in parts 1 and 2, respectively, and 73% adhered to the national guidelines. Many units monitored mechanical (42%) and infectious (69%) complications. Ultrasound was used by more than 50%. Checklists for insertion were used by 22%. Physicians inserted most catheters. No serious complications were reported during the 24-h study period. Ninety-seven non-tunnelled, 17 venous ports, 9 tunnelled and 8 peripheral central venous catheters were inserted. Ninety-three (71%) catheters were inserted in operating rooms, and 31 (24%) in intensive care units. Catheterisations were followed up by chest X-ray in most departments.

    CONCLUSION: Knowledge of the Swedish guidelines was adequate, and most participating departments had local catheterisation routines. We could identify some variation in practice, but overall adherence to the guidelines was good. Nevertheless, monitoring of procedures and complications of cannulation and maintenance could be in need of improvement.

  • 240.
    Lipcsey, Miklos
    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.
    Chiong, Jonathan
    Subiakto, Ivan
    Kaufman, Melissa A.
    Schneider, Antoine G.
    Bellomo, Rinaldo
    Primary fluid bolus therapy for infection-associated hypotension in the emergency department2015Ingår i: CRITICAL CARE AND RESUSCITATION, ISSN 1441-2772, Vol. 17, nr 1, s. 6-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The physiological changes associated with fluid bolus therapy (FBI) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. Methods: We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP) <100 mmHg who underwent FBI in the first 6 hours. Results: We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBI volume given was 1570 mL (interquartile range, 1000 2490 mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66 mmHg [SD, 10 mmHg]) to its value at 6 hours (73 mmHg [SD, 12 mmHg]; P < 0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P < 0.05). In patients who were severely hypotensive (SBP <90 mmHg) on arrival at the ED, the MAP increased from 54 mmHg (SD, 8 mmHg) to 70 mmHg (SD, 14 mmHg) (P < 0.001). At 6 hours, however, SBP was still <100 mmHg in 44 patients and <90 mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58 mmHg (SD, 9 mmHg) to 75 mmHg (SD, 13 mmHg). Conclusion: Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of > 100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.

  • 241.
    Lipcsey, Miklos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Chua, Horng-Ruey
    Schneider, Antoine G
    Robbins, Raymond
    Bellomo, Rinaldo
    Clinically manifest thromboembolic complications of femoral vein catheterization for continuous renal replacement therapy2014Ingår i: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 29, nr 1, s. 18-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    The safety of femoral vein (FV) catheterization for continuous renal replacement therapy is uncertain. We sought to determine the incidence of clinically manifest venous thromboembolism (VTE) in such patients.

    METHODS:

    We retrospectively studied patients with femoral high flow catheters (≥13F) (December 2005 to February 2011). Discharge diagnostic codes were independently screened for VTE. The incidence of VTE was also independently similarly assessed in a control cohort of patients ventilated for more than 2 days (January 2011 to December 2011) in the same intensive care unit (ICU).

    RESULTS:

    We studied 380 patients. Their mean age was 61 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation III score was 84; average duration of continuous renal replacement therapy was 74 hours, and 232 patients (61%) survived to hospital discharge with an average length of hospital stay of 22 days. Only 5 patients (1.3%) had clinically manifest VTE after FV catheterization. In the control cohort of 514 ICU patients, the incidence of VTE was 4.4% (P < .05 compared with FV group).

    CONCLUSION:

    The incidence of clinically manifest VTE after FV catheterization with high flow catheters is low and lower to that seen in general ICU patients.

  • 242.
    Lipcsey, Miklos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Subiakto, Ivan
    Austin Hosp, Dept Intens Care, Melbourne, Vic, Australia..
    Chiong, Jonathan
    Austin Hosp, Dept Intens Care, Melbourne, Vic, Australia..
    Kaufman, Melissa A.
    Austin Hosp, Dept Intens Care, Melbourne, Vic, Australia..
    Schneider, Antoine G.
    Austin Hosp, Dept Intens Care, Melbourne, Vic, Australia..
    Bellomo, Rinaldo
    Austin Hosp, Dept Intens Care, Melbourne, Vic, Australia.;Monash Univ, Sch Publ Hlth & Prevent Med, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia..
    Epidemiology of secondary fluid bolus therapy for infection-associated hypotension2016Ingår i: CRITICAL CARE AND RESUSCITATION, ISSN 1441-2772, Vol. 18, nr 3, s. 165-173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Fluid bolus therapy (FBT) is a common therapy for hypotensive sepsis, but no studies have compared primary FBT (in the first 6 hours after presentation to the emergency department [ED]) with secondary FBT (6-24 hours after presentation to the ED). We aimed to describe the patterns of use, physiological sequelae and outcomes of patients with hypotensive sepsis who were treated with primary FBT or combined primary and secondary FBT (secondary FBT). Design, setting and patients: A retrospective observational study of patients with hypotensive sepsis presenting to the ED of a tertiary hospital from 1 January to 31 December 2010. Results: We studied 100 consecutive eligible patients (primary FBT, n = 52; secondary FBT, n = 48). Secondary FBT occurred in the ward (n = 31) or in the intensive care unit (n = 17). More patients receiving secondary FBT had sepsis with undefined focus or septic shock (P = 0.005, P = 0.0001, respectively), and fewer patients receiving secondary FBT had pneumonia (P = 0.0004). At 24 hours, the use of secondary FBT was similar for patients admitted to the ward and the ICU, and represented about 40% of all secondary fluids given. The volume of any bolus was greater during primary resuscitation, and the size of physiological changes associated with FBT diminished with time. The mortality rate at 28 days was 27%, and was similar for ward and ICU admissions. Conclusions: Secondary FBT is given to about half of patients presenting with hypotensive sepsis, takes place in wards more often than in the ICU and delivers a significant proportion of overall fluids, but is associated with limited changes in measured physiological variables.

  • 243.
    Lipcsey, Miklos
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Pischke, Soeren E
    Department of Immunology, University of Oslo, 0450 Oslo, Norway..
    Kuitunen, Anne
    Department of Intensive Care, University of Tampere and Tampere University Hospital, Tampere, Finland..
    Flaatten, Hans
    Department of Clinical Medicine, Haukeland University Hospital, UiB Bergen, Norway..
    De Geer, Lina
    Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden..
    Sjölin, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Frithiof, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Chew, Michelle S
    Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden..
    Bendel, Stepani
    Department of intensive care, Kuopio University Hospital, Kuopio, Finland..
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Mollnes, Tom Eirik
    Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway..
    Tønnessen, Tor Inge
    Division of Emergencies and Critical Care, Oslo University Hospital 0450 Oslo, and Institute of Clinical Medicine University of Oslo, 0316 Oslo, Norway..
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Endotoxin Removal in Septic Shock with the Alteco® LPS Adsorber was Safe But Showed No Benefit Compared to Placebo in the Double-Blind Randomized Controlled Trial - the Asset Study.2019Ingår i: Shock, ISSN 1073-2322, E-ISSN 1540-0514Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Lipopolysaccharides (LPS) are presumed to contribute to the inflammatory response in sepsis. We investigated if extracorporeal Alteco® LPS Adsorber for LPS removal in early Gram-negative septic shock was feasible and safe. Also, effect on endotoxin level, inflammatory response and organ function were assessed.

    METHODS: A pilot, double-blinded, randomized, Phase IIa, feasibility clinical investigation was undertaken in six Scandinavian intensive care units aiming to allocate thirty-two septic shock patients with abdominal or urogenital focus to LPS Adsorber therapy or a Sham Adsorber, therapy without active LPS-binding. The study treatment was initiated within 12 hours of inclusion and given for six hours daily on first two days. LPS was measured in all patients.

    RESULTS: The investigation was terminated after 527 days with eight patients included in the LPS Adsorber group and seven in the Sham group. Twenty-one adverse effects, judged not to be related to the device, were reported in three patients in the LPS Adsorber group and two in the Sham group. Two patients in the Sham group and no patients in the LPS Adsorber group died within 28 days. Plasma LPS levels were low without groups differences during or after adsorber therapy. The changes in inflammatory markers and organ function were similar in the groups.

    CONCLUSIONS: In a small cohort of patients with presumed Gram-negative septic shock, levels of circulating endotoxin were low and no adverse effects within 28 days after LPS adsorber-treatment were observed. No benefit compared to a sham device was seen when using a LPS adsorber in addition to standard care.

    TRIAL REGISTRATION: Clinicaltrials.gov NCT02335723. Registered: November 28, 2014.

  • 244.
    Lipcsey, Miklós
    et al.
    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.
    Aronsson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Renlund, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Gedeborg, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Multivariable models using administrative data and biomarkers to adjust for case mix in the ICU2019Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, nr 6, s. 751-760Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Routinely collected laboratory biomarkers could improve control of confounding from disease severity in non-interventional studies of general intensive care unit (ICU) patients. Their ability to predict both short- and long-term mortality was evaluated.

    METHODS: The performance of age, sex, Charlson co-morbidity index, and baseline values of ten predefined blood biomarkers as predictors of 30-day and 1-year mortality was evaluated in 5505 general ICU stays.

    RESULTS: Regression models based on age, sex, Charlson index, and biomarkers were somewhat less accurate in predicting 30-day mortality (c-index 0.83, Brier score 0.27) compared to the SAPS II score (c-index = 0.88, Brier score = 0.09) and in predicting 1-year mortality (c-index = 0.82, Brier score = 0.31) compared to the SAPS II score (c-index = 0.85, Brier score = 0.13). Cystatin C improved predictive ability slightly compared to creatinine, but age and Charlson comorbidity index were more important predictors. Using multiple imputation to replace missing biomarker values notably improved predictive ability of the models.

    CONCLUSIONS: Automatically collected baseline variables are almost as predictive of both short- and long-term mortality in general ICU patients, as the SAPS II score. This can facilitate internal control of confounding in non-interventional studies of mortality using administrative data.

  • 245.
    Lipcsey, Miklós
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Castegren, Markus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bellomo, R
    Hemodynamic management of septic shock2015Ingår i: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 81, nr 11, s. 1262-1272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We present a review of the hemodynamic management of septic shock. Although substantial amount of evidence is present in this area, most key decisions on the management of these patients remain dependent on physiological reasoning and on pathophysiological principles rather than randomized controlled trials. During primary (early) resuscitation, restoration of adequate arterial pressure and cardiac output using fluids and vasopressor and/or inotropic drugs is guided by basic hemodynamic monitoring and physical examination in the emergency department. When more advanced level of monitoring is present in these patients, i.e. during secondary resuscitation (later phase in the emergency department and in the ICU), hemodynamic management can be guided by more advanced measurements of the macro--circulation. Our understanding of the microcirculation in septic shock is limited and reliable therapeutic modalities to optimize it do not yet exist. No specific hemodynamic treatment strategy, be it medications including fluids, monitoring devices or treatment algorithms has yet been proved to improve outcome. Moreover, there is virtually no data on the optimal management of the resolution phase of septic shock. Despite these gaps in knowledge, the data from observational studies and trials suggests that mortality in septic shock has been generally decreasing during the last decade.

  • 246.
    Lipcsey, Miklós
    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.
    Castegren, Markus
    Karolinska Univ Hosp, Dept Anaesthesia, Intens Care Serv, Solna, Sweden; Karolinska Univ Hosp, Dept Anaesthesia, Surg Serv, Solna, Sweden.
    Furebring, Mia
    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.
    Sjölin, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Should the Aminoglycoside β-Lactam Combination Be Abandoned in All Severely Ill Patients With Presumed Gram-Negative Infection?2018Ingår i: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 66, nr 3, s. 480-482Artikel i tidskrift (Övrigt vetenskapligt)
  • 247.
    Lipcsey, Miklós
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Mcnicol, L.
    Austin Hosp, Dept Anaesthesia, Melbourne, Vic 3084, Australia..
    Parker, F.
    Austin Hosp, Dept Anaesthesia, Melbourne, Vic 3084, Australia..
    Poustie, S.
    Austin Hosp, Dept Anaesthesia, Melbourne, Vic 3084, Australia..
    Liu, G.
    Austin Hosp, Dept Anaesthesia, Melbourne, Vic 3084, Australia..
    Uchino, S.
    Jikei Univ, Dept Intens Care, Tokyo, Japan..
    Kattula, A.
    Alfred Hlth, Clin Practice Improvement, Melbourne, Vic, Australia..
    Bellomo, R.
    Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia..
    Effect of perfusion pressure on the splanchnic circulation after CPB: a pilot study2015Ingår i: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 81, nr 7, s. 752-764Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. The impact of different blood pressure targets is unknown for post cardiac surgery patient in the intensive care unit. We, therefore, investigated the effects of a mean arterial pressure (MAP) target of 65 or 85 mmHg on splanchnic oxygenation, metabolic function, cytokine regulation and gastric tonometry after cardiopulmonary bypass. Methods. Sixteen patients were randomized to the HLH group (high-low-high) where MAP of 85-65-85 mmHg was targeted or the LHL group where MAP 65-85-65 mmHg was targeted with norepinephrine Results. MAP targets were achieved in all patients at all timepoints (64 +/- 3, 84 +/- 4; 65 +/- 5, LHL group; vs. 84 +/- 3; 66 +/- 2; 85 +/- 5 mmHg, HLH group). At corresponding timepoints, hepatic venous saturation was 41 +/- 15%; 58 +/- 24%; 56 +/- 21% in the LHL group vs. 50 +/- 19%; 43 +/- 20%; 41 +/- 18% in the HLH group (P<0.05). No changes were observed in cardiac output, global or trans-splanchnic lactate levels and cytokine levels or in gastric tonometry CO2. Conclusion. Achieving a MAP target of 85 mmHg by means of norepinephrine infusion after CPB appears safe for the splanchnic circulation.

  • 248.
    Lipcsey, Miklós
    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.
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sjölin, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Frithiof, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Bendel, Stepani
    Kuopio Univ Hosp, Dept Intens Care, Kuopio, Finland..
    Flaatten, Hans
    UiB, Haukeland Univ Hosp, Dept Clin Med, Bergen, Norway..
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kuitunen, Anne
    Tampere Univ Hosp, Crit Care Med Res Grp, POB 200033521, Tampere, Finland..
    Tonnessen, Tor Inge
    Oslo Univ Hosp, Div Emergencies & Crit Care, N-0450 Oslo, Norway.;Inst Clin Med, N-0450 Oslo, Norway..
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Abdominal Septic Shock - Endotoxin Adsorption Treatment (ASSET) - endotoxin removal in abdominal and urogenital septic shock with the Alteco (R) LPS Adsorber: study protocol for a double-blinded, randomized placebo-controlled trial2016Ingår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, artikel-id 587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Severe sepsis and septic shock are common in intensive care and carry high mortality rates. In patients with Gram-negative infections, early and extensive removal of endotoxin may limit the inflammatory response that characterizes septic shock. The Alteco (R) LPS Adsorber (hereafter referred to cited as the lipopolysaccharide (LPS) Adsorber) can be used for endotoxin removal and attenuate the deleterious inflammatory and clinical responses seen in septic shock. Methods/design: The Abdominal Septic Shock - Endotoxin Adsorption Treatment (ASSET) trial is a pilot study investigating the feasibility and safety of LPS Adsorber therapy. This pilot, multicenter, stratified, parallel, double-blinded, randomized, phase IIa, feasibility clinical investigation will be performed in five Scandinavian intensive care units. Thirty-two subjects with early septic shock and organ failure, following adequate resuscitation, will be randomized to receive either: extracorporeal veno-venous hemoperfusion therapy with the LPS Adsorber or veno-venous hemoperfusion therapy with a placebo adsorber (without active LPS-binding peptide). Patients will be stratified by infection focus such that 20 subjects with an abdominal focus (stratum A) and 12 subjects with a urogenital focus (stratum B) will be included in a parallel design. Thereafter, an interim analysis will be performed and an additional 12 patients may be included in the study. The study is designed as adaptive a priori: the patients from this study can be included in a later phase IIb study. The aim of the study is to investigate the feasibility of LPS Adsorber therapy commenced early in the time-course of septic shock. The primary endpoint will be a characterization of all reported unanticipated serious adverse device effects and anticipated serious adverse device effects. Secondary outcomes are decrease in endotoxin plasma concentration, impact on clinical outcome measures and impact on inflammatory response by LPS Adsorber therapy, as well as detailed description of the relevant mediators bound to the LPS Adsorber. Recruitment of patients will start in September 2015. Discussion: The ASSET trial will give insight into the feasibility and safety of this LPS Adsorber therapy and preliminary data on its potential clinical effects in septic shock. Moreover, this pilot trial will provide with necessary data for designing future studies.

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  • 249.
    Liu, Xiaoli
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Experimental cardiopulmonary cerebral resuscitation: with special reference to cerebral eicosanoid production and free radical scavengers2002Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Reperfusion injury after restoration of spontaneous circulation (ROSC) is often considered one of the predominant factors in determining neurological outcome in cardiac arrest. Therefore one of the main targets of experimental and clinical studies has been to mitigate this reperfusion injury. Accumulated knowledge indicates that oxidative stress is perhaps the foremost cause of this reperfusion injury, and hence, free radical scavengers have been tried anticipating mitigation of the effects of ischaemia and reperfusion injury. In this series of experimental porcine studies of cardiac arrest and cardiopulmonary resuscitation (CPR), we aimed to find evidence for increased concentrations of indicators of oxidative stress and inflammation during reperfusion, to mitigate the reperfusion injury by free radiacal scavengers and alkaline buffers, and to improve 24 h neurological outcome by combining effective interventions. The results showed that the isoprostane 8-iso-PGF2alpha, an oxidative indicator, and the prostaglandin 15-keto-dihydro-PGF2alpha, an inflammatory indicator, are significantly increased in the jugular bulb plasma during reperfusion. We confirmed that S-PBN mitigated oxidative stress, as the concentration of 8-iso-PGF2alpha was lower and cerebral vascular autoregulation was better preserved during the early period of reperfusion after ROSC. Combining PBN with cerebral blood flow-promoting interventions, we found that 24 h after ROSC the neurological outcome determined by neurological deficit score (NDS) was significantly improved as compared with two control groups. The concentration of 8-iso-PGF2alpha and hypoxanthine in jugular bulb plasma were correlated to the 24 hy neurological outcome. Alkaline buffer administration during CPR could promote cerebral reperfusion and mitigate cerebral acidosis during the reperfusion period. In summary, reperfusion after ROSC induced oxidative and inflammatory reactions. The eicosanoids, 8-iso-PGF2alpha and 15-keto-dihydro-PGF2alpha determined in jugular bulb plasma can be used as biomarkers of cerebral oxidative and inflammatory reactions, and for evaluating the effectiveness of interventions. The free radical scavengers PBN and S-PBN could mitigate oxidative stress and promote distribution of cerebral cortical blood flow (CCBF). Combineing measures to promote cerebral blood flow and free radical scavenger PBN significantly improved neurological outcome 24 h after ROSC. Administration of alkaline buffers mitigates cerebral acidosis and promotes CCBF in the reperfusion phase after ROSC.

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  • 250.
    Longo, Silvina
    et al.
    Hosp Privado Univ Cordoba, Dept Anesthesia, Cordoba, Argentina..