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  • 101.
    Walther, Sten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Jonasson, U
    Karlsson, Susanne
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan.
    Nordlund, Per-Johan
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för systemteknik.
    Johansson, A
    Malstam, J
    Multicentre study of validity and interrater reliability of the modified Nursing Care Recording System (NCR11) for assessment of workload in the ICU2004Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, nr 6, s. 690-696Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Reliable assessment of nursing workload is necessary for the quantitative approach to staffing of intensive care units. The Nursing Care Recording System (NCR11) scores both the nursing contribution to patient care and those related to medical procedures. The purpose of the present work was to compare NCR11 scoring with the Therapeutic Intervention Scoring System (TISS) and Nine Equivalents of Nurse Manpower use Score (NEMS) and to examine the interrater reliability of NCR11 scoring. Methods: Bias and precision of workload scores (NCR11 vs. TISS or NEMS) were assessed for 6126 consecutive admissions (23910 ICU-days) at three intensive care units. Inter-rater reliability was analyzed by having nurses at nine ICUs score workload using NCR11 for three dummy intensive care patient cases presented over a 3-year period. Variability in scoring was analyzed using the coefficient of variation. Results: Agreement between NCR11 and TISS or NEMS was poor and limits of agreement were wide. Linear relationships between NCR11 and TISS or NEMS scores differed between units. Variability in NCR11 scoring decreased significantly from 10.4% to 5.9% between dummy cases 1 and 2 and remained low for patient case 3. Conclusion: The NCR11 does not measure the same elements of workload in the ICU as do TISS and NEMS. Inter-rater reliability with NCR11 is good, showing little variation in scoring between nurses.

  • 102.
    Walther, Sten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Jonasson, Ulf
    Norrköping.
    A prospective cohort study of 6-month mortality in a community hospital experiencing a gradual reduction in critical care services2001Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, nr 4, s. 700-705Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To analyse the effect of reduction of critical care services on admissions, resource consumption and outcome. Design: Observation outcome study with analysis of patient data collected prospectively during 1993, 1995 and 1997. Setting: High dependency and intensive care unit (HDU/ICU) of a community hospital serving a population of 168,000. The number of beds decreased from 12 (1993), to 10 (1995) and to 8 (1997) with concomitant decrease in staff. Patients and participants: Three patient cohorts admitted to the HDU/ICU during 1993, 1995 and 1997. Measurements and results: Admissions were classified into recovery room care or critical care admissions and stratified according to workload (Levels I-IV). Illness severity scores of critical care admissions were recorded according to the APACHE II system. Mortality data were acquired from a national database. The total number of admissions to the unit did not change over the years. Length of stay decreased significantly over the years. Standardised mortality rates based on mortality within 30 days of discharge from the HDU/ICU were 1.17 (95% confidence interval 0.96-1.43) for critical care admissions during 1993, 0.86 (0.70-1.06) for 1995 and 0.98 (0.79-1.22) for 1997. Survival 180 days after discharge from the HDU/ICU did not differ significantly over the years. Conclusions: The results suggest that an excess of resources were used in critical care services during 1993 and 1995. Reduction of HDU/ICU beds by 30% from 7.1 to 4.8 beds/100,000 was not associated with increased 6-month mortality of the patients admitted.

  • 103.
    Walther, Sten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Jonasson, Ulla
    Norrköping.
    Gill, Hans
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik.
    A comparison of The Glasgow coma scale and the reaction level scale in the critically ill.2003Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 29, s. 933-938Artikel i tidskrift (Refereegranskat)
  • 104.
    Walther, Sten
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Karlström, Göran
    Swedish Intensive Care Registry, Sweden.
    National ICU registries2016Ingår i: Quality management in intensive care: A Practical Guide / [ed] Bertrand Guidet, Andreas Valentin, Hans Flaatten, Cambridge: Cambridge University Press, 2016, s. 195-203Kapitel i bok, del av antologi (Refereegranskat)
  • 105.
    Walther, Sten M.
    Linköpings universitet, Institutionen för medicin och hälsa. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    National ICU registries: Collaboration between ICU registries.2015Konferensbidrag (Refereegranskat)
  • 106.
    Walther, Sten M.
    Linköpings universitet, Institutionen för medicin och hälsa. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Registerdata bidrar till bättre vård - exempel från Svenska Intensivvårdsregistret2015Konferensbidrag (Refereegranskat)
  • 107.
    Walther, Sten M.
    Linköpings universitet, Institutionen för medicin och hälsa. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    The critical ill elderlyu patient. Survived the ICU - now what?2015Konferensbidrag (Refereegranskat)
  • 108.
    Walther, Sten M.
    Linköpings universitet, Institutionen för medicin och hälsa. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    The Swedish Intensive Care Registry: An impact on quality of care?2015Konferensbidrag (Refereegranskat)
  • 109.
    Walther, Sten M
    et al.
    Department of Intensive Care, Ulleva°l University Hospital, Oslo, Norway.
    Johansson, Mats
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Flatebø, Torun
    Department of Physiology, University of Oslo, Oslo, Norway.
    Nicolaysen, Anne
    Department of Physiology, University of Oslo, Oslo, Norway.
    Nicolaysen, Gunnar
    Department of Physiology, University of Oslo, Oslo, Norway.
    Marked differences between prone and supine sheep in effect of PEEP on perfusion distribution in zone II lung2005Ingår i: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 99, nr 3, s. 909-914Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The classic four-zone model of lung blood flow distribution has been questioned. We asked whether the effect of positive end-expiratory pressure (PEEP) is different between the prone and supine position for lung tissue in the same zonal condition. Anesthetized and mechanically ventilated prone (n = 6) and supine (n = 5) sheep were studied at 0, 10, and 20 cmH2O PEEP. Perfusion was measured with intravenous infusion of radiolabeled 15-μm microspheres. The right lung was dried at total lung capacity and diced into pieces (≈1.5 cm3), keeping track of the spatial location of each piece. Radioactivity per unit weight was determined and normalized to the mean value for each condition and animal. In the supine posture, perfusion to nondependent lung regions decreased with little relative perfusion in nondependent horizontal lung planes at 10 and 20 cmH2O PEEP. In the prone position, the effect of PEEP was markedly different with substantial perfusion remaining in nondependent lung regions and even increasing in these regions with 20 cmH2O PEEP. Vertical blood flow gradients in zone II lung were large in supine, but surprisingly absent in prone, animals. Isogravitational perfusion heterogeneity was smaller in prone than in supine animals at all PEEP levels. Redistribution of pulmonary perfusion by PEEP ventilation in supine was largely as predicted by the zonal model in marked contrast to the findings in prone. The differences between postures in blood flow distribution within zone II strongly indicate that factors in addition to pulmonary arterial, venous, and alveolar pressure play important roles in determining perfusion distribution in the in situ lung. We suggest that regional variation in lung volume through the effect on vascular resistance is one such factor and that chest wall conformation and thoracic contents determine regional lung volume. Copyright © 2005 the American Physiological Society.

  • 110.
    Walther, Sten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Mårdh, C
    Karlström, G
    Nolin, T
    For how long does the excess mortality of ICU patients last?2007Ingår i: in Acta anaesthesiologica Scandinavica. Supplementum, ISSN 0515-2720, vol 51, 2007, Vol. 51, s. 11-12Konferensbidrag (Refereegranskat)
  • 111.
    Walther, Sten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Mårdh, C
    Karlström, G
    Nolin, T
    Tracking survival after ctirical illness: how short is too short and how long is long enough?2007Ingår i: in Intensive Care Medicine(ISSN 0342-4642), vol 33, 2007, Vol. 33, s. 95-95Konferensbidrag (Refereegranskat)
  • 112.
    Walther, Sten
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Nolin, Thomas
    Central Hospital, Kristianstad, Sweden.
    Unexpected gender bias among organ donors in Sweden during 2009-2013. A nationwide observational study.2015Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, nr Suppl. 121, artikel-id O13-09Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: The  gap  between the  number of  organ  donors   and patients on waiting lists for transplantation is wide  globally. Understanding  reasons   for  variation in  organ  donation  between and  within  countries may  lead  to  increased availability of organs for transplantation.  The  purpose of  the  present analysis   was  to examine age and  gender of organ  donors  in Sweden.

    Methods:   All  deaths  in  Swedish   ICUs   during  2009–2013  were examined using  a prospectively determined protocol  comprising 10 primary questions. Protocols  were sent electronically to the  Swed- ish  Intensive   Care  Registry   (SIR) for  validation and   then joined with  the  appropriate ICU admission in the  SIR database. The rela- tionship between organ  donation and gender  was analysed using logistic  regression adjusted for  age  and comorbidities (as  defined in the SAPS3 model)  and  presented as odds  ratios  (OR).

    Results:   The female to male ratio (F/M) was 0.72 in ICU admissions and  ICU deaths, while the  organ  donor  F/M was  1.06. Almost  all organ  donors  (98%) were found  in 4 major diagnostic groups which all showed a disproportionate high female donor  rate (Table). Mean age in female organ donors  was 54.9 (SD 16.5) years. and in men 53.5 (18.3) years,  P = 0.48. The crude  female  OR for becoming a donor was 1.47 (95% CI: 1.25–1.74, P < 0.001), and the adjusted OR was 1.55 (95% CI: 1.28–1.88, P < 0.001).

    Table 1 Source: https://www.eventure-online.com/parthen-uploads/154/SSAI/img1_264985_Nxx2LShLTc.jpg.

    Conclusion: During the critical pathway for organ donation after brain death the F/M ratio unexpectedly rose. Why and when  men became underrepresented in this pathway needs further study.

  • 113.
    Walther, Sten
    et al.
    Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Orwelius, Lotti
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US (ANOPIVA). Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad.
    Kristensson, M.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Sjöberg, Folke
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US (ANOPIVA). Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi.
    Influence of income and education on outcomes of intensive care in a healthcare system with full universal health insurance - a nationwide analysis of individual-level data2019Ingår i: Intensive Care Medicine Experimental, ISSN 1646-2335, E-ISSN 2197-425X, Vol. 7, nr Supplement 3, artikel-id 000224Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    INTRODUCTION. Most patients admitted to intensive care are discharged to a general ward in the same hospital, but some patients require transfer to another hospital. Indications for interhospital transfers (IHT) include referral for specialist treatment, lack of intensive care beds at the referring ICU and repatriation to ICU in home hospital [1].

    OBJECTIVES. To review mortality of ICU-patients undergoing IHT and analyse whether different indications for transfer render different mortalities.

    METHODS. Retrospective cohort register study using the Swedish Intensive Care Registry (SIR) during 2016-2018. The SIR collects data from 98.8% of Swedish ICUs including data on discharge from ICUs to other hospitals/ICUs. Transfers were divided into three categories: transfer due to medical reasons, lack of ICU beds or repatriation to ICU in home hospital. We analysed odds ratios (ORs) for dying within 30 days after discharge from ICU using risk adjusted (SAPS3 score) multi-level mixed effect logistic regression with ICUs as random effect.

    RESULTS. We identified 12,356 patients who were discharged to another ICU and hospital, i.e. inter-hospital transfers. The unadjusted mortality 30 days after IHT was 17.2 % compared to 12.4 % if discharged to ward in the same hospital. Mortality after IHT varied with the cause of discharge (Figure).Main diagnoses for transfer due to specialist treatment were subarachnoid haemorrhage, head injury and multi-trauma whilst for lack of ICU beds post cardiac arrest, respiratory failure and pneumonia dominated. Risk adjusted analysis showed a significantly increased risk of dying after discharge due to lack of ICU-beds in comparison with other reasons for IHTs

    CONCLUSION. The adjusted risk of dying within 30 days after interhospital transfer was greater among critically ill patients when the transfer was due to lack of beds in the referring ICU. The increased mortality lingered for at least 6 months underlining the importance to identify causes and intervene to avoid unnecessary loss of life.

  • 114.
    Walther, Sten
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Wickberg, S
    Karlström, G
    Putting focus on night-time discharge from ICU to general wards has decreased the incidence and reduced the association with mortality2013Konferensbidrag (Refereegranskat)
  • 115.
    Walther, Sten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Wickerts, C-J
    Store regionala skillnader i svensk intensivvård. Lägst antal vårdplaster i storstadsregionerna visar rikstäckande enkätstudie (Distribution of beds and staffing in Swedish intensive care units)2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, s. 3768-3773Artikel i tidskrift (Övrigt vetenskapligt)
  • 116.
    Wang, Jianpu
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Abu-Zidan, Fikri
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Linköpings universitet, Hälsouniversitetet.
    Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury2002Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, nr 9, s. 1094-1102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chlorine gas may induce severe acute lung injury. Improvement of pulmonary gas exchange in patients and animals with acute lung injury nursed in the prone position was observed in recent years. The purpose of this study was to evaluate the effects of prone and supine positions on pulmonary and cardiovascular functions following experimental chlorine gas lung injury.

    Methods: Twenty anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 p.p.m. in air) for 20 min in the supine position, then assigned randomly to ventilation in the supine or prone positions (n=10 in each group). Hemodynamics, gas exchange, lung mechanics and oxygen transport were evaluated for 5 h.

    Results: All animals showed severe pulmonary dysfunction immediately after chlorine gassing with a threefold increase in pulmonary vascular resistance index, a drop in arterial oxygenation (12.3±1.3 kPa to 5.4±0.7 kPa) and a fall in lung-thorax compliance (22±1 ml cmH2O−1 to 8±2 ml cmH2O−1). Venous admixture (Qs/Qt) improved in animals in the prone position while there was no change in the supine position (prone 32±11% vs. supine 42±9% at 5 h,P<0.05). Lung-thorax compliance improved significantly with time in the prone group only (P<0.01). Oxygen delivery increased significantly in prone animals compared with animals nursed in the supine posture (P<0.001).

    Conclusion: Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport.

  • 117.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Oldner, A.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Winskog, C.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Edston, Erik
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Effects of endothelin receptor antagonism on acute lung injury induced by chlorine gas2006Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 34, nr 6, s. 1731-1737Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that the endothelin system is involved in chlorine gas-induced lung injury.

    DESIGN: Experimental study.

    SETTING: Academic research laboratory.

    SUBJECTS: Twenty-four domestic juvenile pigs.

    INTERVENTIONS: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million in air) for 20 mins and then randomly allocated to four groups (n = 6 in each group). The tezosentan pretreatment group received the dual endothelin receptor antagonist tezosentan 20 mins before and hyperoxic gas (Fio2 0.6) after chlorine gas exposure. The tezosentan postinjury treatment group received hyperoxic gas after chlorine gas exposure and tezosentan 60 mins later. Animals in the oxygen group received hyperoxic gas after chlorine gas exposure. Pigs in the fourth group (air) were ventilated with room air (Fio2 0.21) throughout the experiment.

    MEASUREMENTS AND MAIN RESULTS: Hemodynamics, gas exchange, lung mechanics, and plasma endothelin-1 were evaluated for 6 hrs. Chlorine gas exposure induced an increase in circulating endothelin-1 by 90% (p < .05). The acute chlorine gas-induced rise in pulmonary vascular resistance was partly blocked by tezosentan pretreatment (p < .001). Tezosentan postinjury treatment also decreased pulmonary vascular resistance to levels significantly lower than in the air and oxygen groups (p < .001). Recovery of peak airway pressure was better in the tezosentan-treated groups than in the air group. There were significant linear relationships between circulating endothelin-1 and pulmonary vascular resistance (r = .47, p < .001) and endothelin-1 and peak airway pressure (r = .41, p < .001). These relationships were modified by tezosentan.

    CONCLUSIONS: Tezosentan modified chlorine gas-induced pulmonary dysfunction, indicating that the endothelin system is involved in this mode of acute lung injury.

  • 118.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Winskog, C.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Edston, Erik
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs2005Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, nr 2, s. 183-190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:  The accidental release of chlorine gas is a constant threat in urban areas. The purpose of this randomized, blinded, controlled experiment was to examine the effects of post-injury administration of inhaled or intravenous corticosteroid in chlorine gas-injured pigs followed for 23 h.

    Methods:  Anaesthetized, ventilated pigs (n = 24) in the prone position were exposed to chlorine gas (400 parts per million in air) (1160 mg/m3) for 15 min, then randomly allocated to receive inhaled budesonide (BUD) and intravenous placebo, intravenous betamethasone (BETA) and inhaled placebo or inhaled and intravenous placebo. Haemodynamics, gas exchange and lung mechanics were evaluated for 23 h after exposure to chlorine gas.

    Results:  Airway and pulmonary artery pressures increased and arterial oxygenation fell sharply (from 13.5 ± 0.8 to 6.7 ± 0.9 kPa, P < 0.001) after chlorine gas exposure. These immediate changes were followed by a gradual improvement over 5–7 h to a stable level of dysfunction for the rest of the experiment in placebo animals. Arterial oxygen tension, pulmonary vascular resistance and airway pressure recovered faster and more completely in the budesonide and betamethasone groups than in the placebo group (P < 0.01). Lung wet weight to dry weight ratios were greater in the placebo group than in the budesonide and betamethasone groups (6.34 ± 0.59 vs. 5.56 ± 0.38 and 5.53 ± 0.54, respectively, P < 0.05). There was a trend towards lower histological injury scores compared with placebo in animals that received budesonide (P = 0.05) or betamethasone (P = 0.07).

    Conclusion:  Treatment of chlorine gas lung injury with nebulized budesonide or intravenous betamethasone had similar positive effects on recovery of lung function.

  • 119.
    Wang, Jianpu
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Zhang, Liming
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Linköpings universitet, Hälsouniversitetet.
    Inhaled budesonide in experimental chlorine gas lung injury: influence of time interval between injury and treatment2002Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 28, nr 3, s. 352-357Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To examine the time window between injury and treatment during which nebulized corticosteroid lessens lung injury induced by chlorine gas inhalation.

    Design: An experimental laboratory study.

    Setting: Academic research laboratory.

    Subjects: Twenty-four juvenile female pigs.

    Interventions: Twenty-four mechanically ventilated pigs were exposed to chlorine gas (400 PPM in air) for 20 min, then divided into four groups (six in each group). Nebulized budesonide (BUD) was given immediately (BUD 0 min), 30 min (BUD 30 min) or 60 min (BUD 60 min) after chlorine gas exposure. Six pigs receiving nebulized saline served as controls.

    Measurements and main results: Hemodynamics, gas exchange and lung mechanics were evaluated for 5 h after chlorine gas exposure. All animals had an immediate increase in airway and pulmonary artery pressure and a sharp drop of arterial oxygenation. The mean arterial oxygen tension of BUD 0 min and BUD 30 min animals was significantly higher than in the control and the BUD 60 min groups (p<0.001). The recovery of lung compliance in the BUD 0 min and the BUD 30 min groups was significantly more rapid than in the control and the BUD 60 min groups (p<0.001). The pulmonary wet to dry weight ratio was greater in the control group than in the BUD-treated groups (p<0.05).

    Conclusion: Treatment with inhaled budesonide immediately or 30 min after chlorine gas lung injury had similar positive effects on symptoms and signs of pulmonary injury, whereas treatment delayed for 60 min was less effective.

  • 120.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Zheng, Limin
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury2004Ingår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, nr 4, s. 850-862Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The pathophysiology and treatment of chlorine gas-induced acute lung injury is poorly characterized and based on anecdotal data. This study aimed to assess the effects of aerosolized beta-2 adrenergic agonist and corticosteroid therapy on chlorine gas-induced lung injury.

    Methods: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million for 20 minutes), then assigned randomly 30 minutes later to receive aerosolized terbutaline, budesonide, terbutaline followed by budesonide or placebo (6 pigs in each group). Hemodynamics, gas exchange, and lung mechanics were evaluated for another 5 hours.

    Results: All the animals demonstrated an immediate increase in airway and pulmonary artery pressure as well as sharp drops in arterial oxygen tension (PaO2) and lung compliance (C L). Recovery of PaO2 and CL was greatest in the terbutaline plus budesonide group, but therapy with terbutaline and budesonide alone also was associated with significant improvement in PaO2 and CL, as compared with placebo.

    Conclusions. Treatment of acute chlorine gas lung injury with aerosolized terbutaline followed by aerosolized budesonide improved lung function. Combined treatment was more effective than treatment with either drug alone.

  • 121. Wickerts, C-J
    et al.
    Walther, Sten
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Registrering och förekomst av avvikelser på svenska intensivvårdsavdelningar - resultat av en enkätundersökning2004Ingår i: SFAI-tidningen, ISSN 0283-8818, Vol. 10, s. 32-36Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 122.
    Wilhelms, SB
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Hälsouniversitetet.
    Huss, F
    Uppsala University, Sweden.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US. Östergötlands Läns Landsting, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Epidemiological investigations of severe sepsis: a comparison of ICD code abstraction strategies to the ACCP/SCCM consensus criteria2013Ingår i: Intensive Care Medicine, 2013Konferensbidrag (Refereegranskat)
  • 123. Winsö, O
    et al.
    Walther, Sten
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Ett svenskt nätverk för klinisk intensivvårdsforskning?2000Ingår i: SFAI-tidningen, ISSN 0283-8818, Vol. 6, s. 10-11Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
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