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  • 351.
    Törnell, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Ekeus, C.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Thunberg, Johan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Högberg, U.
    Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 4, p. 486-495Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. METHODS: Population-based register study with data from the Swedish Birth Register and the Swedish National Patient Register, including all nulliparae (n = 294,329) with singleton pregnancies who gave birth at term in Sweden 1999-2008. Neonatal outcomes analysed were Apgar score (AS) < 7 at 5 min and ICD-10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: EA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS, AOR 1.27 (95% CI 1.16-1.39), but not with diagnosis of encephalopathy, 1.11 (0.96-1.29). A diagnosis of MF was associated with increased risk for both low AS, 2.27 (1.71-3.02), and of neonatal encephalopathy, 1.97 (1.19-3.26). CONCLUSION: Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry-based population study.

  • 352. Valitalo, P.
    et al.
    Ranta, V. -P
    Hooker, Andrew C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Kokki, M.
    Kokki, H.
    Population pharmacometrics in support of analgesics studies2014In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 2, p. 143-156Article, review/survey (Refereed)
    Abstract [en]

    Population pharmacometric modeling is used to explain both population trends as well as the sources and magnitude of variability in pharmacokinetic and pharmacodynamics data; the later, in part, by taking into account patient characteristics such as weight, age, renal function and genetics. The approach is best known for its ability to analyze sparse data, i.e. when only a few measurements have been collected from each subject, but other benefits include its flexibility and the potential to construct more detailed models than those used in the traditional individual curve fitting approach. This review presents the basic concepts of population pharmacokinetic and pharmacodynamic modeling and includes several analgesic drug examples. In addition, the use of these models to design and optimize future studies is discussed. In this context, finding the best design factors, such as the sampling times or the dose, for future studies within pre-defined criteria using a previously constructed population pharmacokinetic model can help researchers acquire clinically meaningful data without wasting resources and unnecessarily exposing vulnerable patient groups to study drugs and additional blood sampling.

  • 353. Villar, J
    et al.
    Kacmarek, R M
    Hedenstierna, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    From ventilator-induced lung injury to physician-induced lung injury: why the reluctance to use small tidal volumes?2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 3, p. 267-71Article in journal (Refereed)
  • 354.
    Vimláti, Laszlo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Lichtwarck-Aschoff, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Haemodynamic stability and pulmonary shunt during spontaneous breathing and mechanical ventilation in porcine lung collapse2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 6, p. 748-754Article in journal (Refereed)
    Abstract [en]

    Background

    We investigated the haemodynamic stability of a novel porcine model of lung collapse induced by negative pressure application (NPA). A secondary aim was to study whether pulmonary shunt correlates with cardiac output (CO).

    Methods

    In 12 anaesthetized and relaxed supine piglets, lung collapse was induced by NPA (−50 kPa). Six animals resumed spontaneous breathing (SB) after 15 min; the other six animals were kept on mechanical ventilation (MV) at respiratory rate and tidal volume (VT) that corresponded to SB. All animals were followed for 135 min with blood gas analysis and detailed haemodynamic monitoring.

    Results

    Haemodynamics and gas exchange were stable in both groups during the experiment with arterial oxygen tension (PaO2)/inspired fraction of oxygen (FiO2) and pulmonary artery occlusion pressure being higher, venous admixture (Qva/Qt) and pulmonary perfusion pressure being lower in the SB group. CO was similar in both groups, showing slight decrease over time in the SB group. During MV, Qva/Qt increased with CO (slope: 4.3 %min/l; P < 0.001), but not so during SB (slope: 0.55 %min/l; P = 0.16).

    Conclusions

    This porcine lung collapse model is reasonably stable in terms of haemodynamics for at least 2 h irrespective of the mode of ventilation. SB achieves higher PaO2/FiO2 and lower Qva/Qt compared with MV. During SB, Qva/Qt seems to be less, if at all, affected by CO compared with MV.

  • 355. Vistisen, S. T.
    et al.
    Koefoed-Nielsen, J.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Should dynamic parameters for prediction of fluid responsiveness be indexed to the tidal volume?2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 2, p. 191-198Article in journal (Refereed)
    Abstract [en]

    Background: The respiratory variation in the pre-ejection period (DeltaPEP) has been used to predict fluid responsiveness in mechanically ventilated patients. Recently, we modified this parameter (PEPV) and showed that it was a reliable predictor for post-cardiac surgery, mainly paced, patients when moderately low tidal volumes were used. One of the modifications involved tidal volume indexation, which had not been proposed before for dynamic parameters. The aim of the present animal study was to investigate whether indexation to tidal volume should be part of a new definition of dynamic parameters such as the case for our newly proposed PEPV. Methods: Eight prone, anesthetized piglets (23-27 kg) were subjected to a sequence of 25% hypovolemia, normovolemia, and 25% and 50% hypervolemia. At each volemic level, tidal volumes were varied in three steps: 6, 9, and 12 ml/kg. PEP variations (ms) and pulse-pressure variation (PPV) were measured during the three tidal volume steps at each volemic level. Results: PEP variations increased significantly with increasing tidal volume at all volemic levels but 50% hypervolemia and were proportionally related to the tidal volume at normovolemia. PPV increased significantly with increasing tidal volume at all volemic levels and was roughly proportional to the tidal volume at all volemic levels but hypovolemia. Conclusion: Our study indicates that dynamic parameters are improved by indexing to tidal volume.

  • 356. Vistisen, Simon Tilma
    et al.
    Koefoed-Nielsen, J.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Automated pre-ejection period variation predicts fluid responsiveness in low tidal volume ventilated pigs2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 2, p. 199-205Article in journal (Refereed)
    Abstract [en]

    Introduction: The respiratory variation in the pre-ejection period (DeltaPEP) has been used to predict fluid responsiveness in mechanically ventilated patients. Recently, we automated this parameter and indexed it to tidal volume (PEPV) and showed that it was a reliable predictor for post-cardiac surgery, mainly paced, patients ventilated with low tidal volumes. The aims of the present animal study were to investigate PEPV's ability to predict fluid responsiveness under different fluid loading conditions and natural heart rates during low tidal volume ventilation (6 ml/kg) and to compare the performance of PEPV with other markers of fluid responsiveness. Methods: Eight prone, anesthetized piglets (23-27 kg) ventilated with tidal volumes of 6 ml/kg were subjected to a sequence of 25% hypovolemia, normovolemia, and 25% and 50% hypervolemia. PEPV, DeltaPEP, pulse pressure variation (PPV), central venous pressure (CVP), and pulmonary artery occlusion pressure (PAOP) were measured before each volume expansion. Results: Sensitivity was 89% and specificity was 93% for PEPV, 78% and 93% for DeltaPEP, 89% and 100% for PPV, 78% and 93% for CVP, and 89% and 87% for PAOP. Conclusion: PEPV predicts fluid responsiveness in low tidal volume ventilated piglets.

  • 357. Vistisen, Simon Tilma
    et al.
    Struijk, J. J.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Automated pre-ejection period variation indexed to tidal volume predicts fluid responsiveness after cardiac surgery2009In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 4, p. 534-42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Reliable continuous monitoring of fluid responsiveness is an unsolved issue in patients ventilated with low tidal volume. We hypothesised that variations in the pre-ejection period (PEP) defined as the time interval between electrocardiogram (ECG) R-wave and onset of systolic upstroke in arterial blood pressure could reliably predict fluid responsiveness in patients ventilated with moderately low tidal volume. Furthermore, we hypothesised that indexing dynamic parameters to tidal volume would improve their prediction. The aim was to refine and automate a previously suggested algorithm for PEP variation (DeltaPEP) and to test this new parameter indexed to tidal volume (PEPV), as a marker of fluid responsiveness along with central venous pressure (CVP), pulse pressure variation (PPV) and DeltaPEP. Additionally, the aim was to evaluate the concept of indexing dynamic parameters to tidal volume. METHODS: Arterial pressure, CVP, ECG and cardiac index (CI) were acquired from 23 mechanically ventilated post-cardiac surgery patients scheduled for volume expansion. PEPV, PPV and DeltaPEP were extracted. RESULTS: Using responder/non-responder classification (response=change in CI>+15%), sensitivity and specificity were 100% and 83%, respectively, for PEPV, 94% and 83% for DeltaPEP, and 94% and 83% for PPV. CVP offered no relevant information. Tidal volume indexing improved sensitivity for DeltaPEP to 100%. CONCLUSION: In this study in post-cardiac surgery patients, a refined parameter, PEPV, predicted fluid responsiveness better than PPV and DeltaPEP. Our results suggest that dynamic parameters using variations in PEP should be indexed to tidal volume.

  • 358.
    Vogel, G.
    et al.
    Södersjukhuset;Karolinska Institutet.
    Forinder, U.
    University of Gävle.
    Sandgren, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Svensen, C.
    Södersjukhuset;Karolinska Institutet.
    Joelsson-Alm, E.
    Södersjukhuset;Karolinska Institutet.
    Health-related quality of life after general surgical intensive care2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 8, p. 1112-1119Article in journal (Refereed)
    Abstract [en]

    BackgroundImpaired mental and physical health are common complications after intensive care that could influence the patient's health-related quality of life (HRQoL). Earlier research has mainly focused on HRQoL in mixed surgical and medical ICU populations. This study aimed to describe and analyze factors associated with HROoL after discharge from a general surgical ICU. MethodsA prospective cohort study was conducted in a general surgical ICU in Sweden between 2005 and 2012. Adult patients (18years) with an ICU length of stay 96hours were included. HRQoL was measured at 3, 6, and 12months after discharge from the ICU using a questionnaire (SF-36). A linear mixed model was used to analyze changes over time and Wilcoxon Signed Rank Tests were used to compare the 12-months results to an age and gender matched reference population in Sweden. Linear regression analyses were performed to explore the impact on HRQoL from background variables. ResultsOf 447 patients eligible for the study, 276 patients (62%) answered SF-36 at least once at 3, 6 or 12months after ICU care and were included in the study. HRQoL improved over time but was still significantly lower at 12months compared to the reference population. Female gender, age <75years, living single, and ICU-stay of more than 14days were associated with lower HRQoL. ConclusionGeneral surgical ICU patients reports low HRQoL 1year after ICU stay. The impaired HRQoL could be a long-lasting problem with major consequences for the individual, family, and society.

  • 359.
    Vogel, Gisela
    et al.
    Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology; Intensive Care, Södersjukhuset, Stockholm, Sweden.
    Forinder, Ulla
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Sandgren, A.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Svensen, C.
    Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology; Intensive Care, Södersjukhuset, Stockholm, Sweden.
    Joelsson-Alm, Eva
    Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology; Intensive Care, Södersjukhuset, Stockholm, Sweden.
    Health-related quality of life after general surgical intensive care2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 8, p. 1112-1119Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Impaired mental and physical health are common complications after intensive care that could influence the patient's health-related quality of life (HRQoL). Earlier research has mainly focused on HRQoL in mixed surgical and medical ICU populations. This study aimed to describe and analyze factors associated with HROoL after discharge from a general surgical ICU.

    METHODS: A prospective cohort study was conducted in a general surgical ICU in Sweden between 2005 and 2012. Adult patients (≥18 years) with an ICU length of stay ≥96 hours were included. HRQoL was measured at 3, 6, and 12 months after discharge from the ICU using a questionnaire (SF-36). A linear mixed model was used to analyze changes over time and Wilcoxon Signed Rank Tests were used to compare the 12-months results to an age and gender matched reference population in Sweden. Linear regression analyses were performed to explore the impact on HRQoL from background variables.

    RESULTS: Of 447 patients eligible for the study, 276 patients (62%) answered SF-36 at least once at 3, 6 or 12 months after ICU care and were included in the study. HRQoL improved over time but was still significantly lower at 12 months compared to the reference population. Female gender, age <75 years, living single, and ICU-stay of more than 14 days were associated with lower HRQoL.

    CONCLUSION: General surgical ICU patients reports low HRQoL 1 year after ICU stay. The impaired HRQoL could be a long-lasting problem with major consequences for the individual, family, and society.

  • 360.
    Wallden, J.
    et al.
    Umeå University, Sweden; Sundsvall Hospital, Sweden.
    Halliday, T. A.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Hultin, M.
    Umeå University, Sweden; Sunderby Hospital, Sweden.
    Reply to: Sorbello et al., PONV in bariatric surgery: time for opioid-free anaesthesia2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 7, p. 858-858Article in journal (Other academic)
    Abstract [en]

    n/a

  • 361.
    Walldén, Jakob
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Halliday, T. A.
    Hultin, Magnus
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Reply to: Sorbello et al., PONV in bariatric surgery: time for opioid-free anaesthesia2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 7, p. 858-858Article in journal (Refereed)
  • 362.
    Walldén, Jakob
    et al.
    Anestesi och Intensivvård, Anesthesiology.
    Lindberg, G
    Sandin, M
    Thörn, S-E
    Wattwil, M
    Effects of fentanyl on gastric myoelectrical activity: a possible association with polymorphisms of the mu-opioid receptor gene?2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 5, p. 708-15Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Opioids have inhibitory effects on gastric motility, but the mechanism is far from clear. Electrical slow waves in the stomach determine the frequency and the peristaltic nature of gastric contractions. The primary aim of this study was to investigate the effects of the opioid fentanyl on gastric myoelectric activity. As there were large variations between the subjects, we investigated whether the variation was correlated to single nucleotide polymorphisms (SNP) of the mu-opioid receptor (MOR) gene.

    METHODS: We used cutaneous multichannel electrogastrography (EGG) to study myoelectrical activity in 20 patients scheduled for elective surgery. Fasting EGG was recorded for 30 min, followed by intravenous administration of fentanyl 1 microg/kg and subsequent EGG recording for 30 min. Spectral analysis of the two recording periods was performed and the variables assessed were dominant frequency (DF) of the EGG and its power (DP). Genetic analysis of the SNP A118G and G691C of the MOR gene was performed with the polymerase chain reaction technique.

    RESULTS: There was a significant reduction in DF and DP after intravenous fentanyl. However, there was a large variation between the patients. In eight subjects EGG was unaffected, five subjects had a slower DF (bradygastria) and in six subjects the slow waves disappeared. We found no correlation between the EGG outcome and the presence of A118G or G691C in the MOR gene.

    CONCLUSIONS: Fentanyl inhibited gastric myoelectrical activity in about half of the subjects. The variation could not be explained by SNP in the MOR gene. Because of small sample size, the results must be regarded as preliminary observations.

  • 363.
    Walldén, Jakob
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lindberg, Greger
    Sandin, Mathias
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences.
    Wattwil, Magnus
    Örebro University, School of Health and Medical Sciences.
    Effects of fentanyl on gastric myoelectrical activity: a possible association with polymorphisms of the mu-opioid receptor gene?2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 5, p. 708-715Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Opioids have inhibitory effects on gastric motility, but the mechanism is far from clear. Electrical slow waves in the stomach determine the frequency and the peristaltic nature of gastric contractions. The primary aim of this study was to investigate the effects of the opioid fentanyl on gastric myoelectric activity. As there were large variations between the subjects, we investigated whether the variation was correlated to single nucleotide polymorphisms (SNP) of the mu-opioid receptor (MOR) gene. METHODS: We used cutaneous multichannel electrogastrography (EGG) to study myoelectrical activity in 20 patients scheduled for elective surgery. Fasting EGG was recorded for 30 min, followed by intravenous administration of fentanyl 1 microg/kg and subsequent EGG recording for 30 min. Spectral analysis of the two recording periods was performed and the variables assessed were dominant frequency (DF) of the EGG and its power (DP). Genetic analysis of the SNP A118G and G691C of the MOR gene was performed with the polymerase chain reaction technique. RESULTS: There was a significant reduction in DF and DP after intravenous fentanyl. However, there was a large variation between the patients. In eight subjects EGG was unaffected, five subjects had a slower DF (bradygastria) and in six subjects the slow waves disappeared. We found no correlation between the EGG outcome and the presence of A118G or G691C in the MOR gene. CONCLUSIONS: Fentanyl inhibited gastric myoelectrical activity in about half of the subjects. The variation could not be explained by SNP in the MOR gene. Because of small sample size, the results must be regarded as preliminary observations.

  • 364.
    Walldén, Jakob
    et al.
    Örebro University, School of Health and Medical Sciences.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences.
    Lindberg, Greger
    Wattwil, Magnus
    Örebro University, School of Health and Medical Sciences.
    Effects of remifentanil on gastric tone2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 7, p. 969-976Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Opioids are well known for impairing gastric motility. The mechanism is far from clear and there is wide interindividual variability. The purpose of this study was to evaluate the effect of remifentanil on proximal gastric tone. MATERIALS AND METHODS: Healthy volunteers were studied on two occasions and proximal gastric tone was measured by a gastric barostat. On the first occasion (n=8), glucagon 1 mg IV was given as a reference for a maximal relaxation of the stomach. On the second occasion (n=9), remifentanil was given in incremental doses (0.1, 0.2 and 0.3 microg/kg/min) for 15 min each, followed by a washout period of 30 min. Thereafter, remifentanil was readministered, and 10 min later glucagon 1 mg was given. Mean intragastric bag volumes were calculated for each 5-min interval. RESULTS: Glucagon decreased gastric tone in all subjects. Remifentanil had a marked effect on gastric tone; we found two distinct patterns of reactions with both increases and decreases in gastric tone and, during the remifentanil infusion, glucagon did not affect gastric tone. CONCLUSIONS: Remifentanil induced changes in gastric tone with both increases and decreases. The effect of remifentanil on gastric tone is probably dependent on the current state of the systems involved.

  • 365.
    Walldén, Jakob
    et al.
    Anestesi och Intensivvård, Anesthesiology.
    Thörn, Sven-Egron
    Lindberg, Greger
    Wattwil, Magnus
    Effects of remifentanil on gastric tone.2008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 7, p. 969-76Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Opioids are well known for impairing gastric motility. The mechanism is far from clear and there is wide interindividual variability. The purpose of this study was to evaluate the effect of remifentanil on proximal gastric tone.

    MATERIALS AND METHODS: Healthy volunteers were studied on two occasions and proximal gastric tone was measured by a gastric barostat. On the first occasion (n=8), glucagon 1 mg IV was given as a reference for a maximal relaxation of the stomach. On the second occasion (n=9), remifentanil was given in incremental doses (0.1, 0.2 and 0.3 microg/kg/min) for 15 min each, followed by a washout period of 30 min. Thereafter, remifentanil was readministered, and 10 min later glucagon 1 mg was given. Mean intragastric bag volumes were calculated for each 5-min interval.

    RESULTS: Glucagon decreased gastric tone in all subjects. Remifentanil had a marked effect on gastric tone; we found two distinct patterns of reactions with both increases and decreases in gastric tone and, during the remifentanil infusion, glucagon did not affect gastric tone.

    CONCLUSIONS: Remifentanil induced changes in gastric tone with both increases and decreases. The effect of remifentanil on gastric tone is probably dependent on the current state of the systems involved.

  • 366.
    Wallin, Ewa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Ing-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Kristofferzon, Marja-Leena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 635-647Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

    METHODS:

    A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

    RESULTS:

    Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

    CONCLUSIONS:

    Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

  • 367.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Elna-Marie
    Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
    Raininko, Raili
    Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 625-647Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

    METHODS:

    A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

    RESULTS:

    Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

    CONCLUSIONS:

    Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

  • 368.
    Wallin, Ewa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Ing-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nordmark-Grass, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rosenqvist, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Kristofferzon, Marja-Leena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 9, p. 1237-1245Article in journal (Refereed)
    Abstract [en]

    Background: Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33 degrees C was applied.

    Method: Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33 degrees C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

    Results: Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

    Conclusions: Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33 degrees C post-CA.

  • 369.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Nordmark-Grass, Johanna
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Rosenqvist, Ivan
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Characteristics of jugular bulb oxygen saturationin patients after cardiac arrest: A prospective study2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 9, p. 1237-1245Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied.

    METHOD:

    Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

    RESULTS:

    Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

    CONCLUSIONS:

    Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.

  • 370.
    Walther, Sten
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Genaridis, Apostolos
    Södersjukhuset, Stockholm, Sweden.
    Berkius, Johan
    Västerviks sjukhus, Västervik, Sweden.
    Wickerts, Carl-Johan
    Swedish Intensive Care Registry, Sweden.
    The effect of non-invasive ventilation on long-term survival in acute hypoxemic respiratory failure. An observational study of 12,428 patients stratified by the Berlin definition gas exchange criteria.2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 121, article id AP-04Article in journal (Other academic)
    Abstract [en]

    Introduction: Noninvasive positive pressure ventilation (NIV) has become a standard therapy for the treatment of respiratory failure in chronic obstructive pulmonary disease (COPD), while the increasing early use in patients with hypoxemic acute respiratory failure (ARF) is controversial. The aim of the present study was to examine the influence of NIV and particularly when NIV was followed by invasive ventilation (NIV+InvV) in hypoxic ARF.

    Methods: The use of early NIV and invasive mechanical ventilation (InvV) was examined in patients admitted with respiratory failure to 70 ICUs during 2008–2014. Exclusions were age < 16 years, patients with COPD, and when oxygenation or ventilation support data were missing. The ratio of PaO2 to FiO2 (P/F) was used to group patients with mild (26.7–40.0 kPa), moderate (13.3–26.6 kPa) and severe (< 13.3 kPa) ARF. Survival was analyzed using a multivariable Cox model after stratification by P/F ratio and adjusting for hospital category, age, comorbidities and derangements in acute physiology (except P/F ratio) as defined in the SAPS3 model.

    Table 1

     Source: https://www.eventure-online.com/parthen-uploads/154/SSAI/img1_264369_fyTYZNs1w9.jpg

    Results: NIV was the initial mode in 48.7% of pts. with hypoxemic ARF. NIV only and NIV+InvV were associated with increased mortality compared to invasive ventilation only (Table). Conclusion: The use of early NIV in hypoxemic ARF was high. NIV was associated with increased mortality which may be explained by residual confounding (i.e. presence/absence of care limitations), although the finding with NIV+InvV is of concern. Early NIV must be used with care in hypoxemic ARF until proper studies have identified patients who truly benefit from NIV.

    Download (png)
    Table (Abstract)
  • 371.
    Walther, Sten
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Gill, H
    n/a.
    Hanberger, H
    n/a.
    Letter: Implementation of selective digestive decontamination in the intensive care unit: a word of caution2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 4, p. 526-527Article in journal (Other academic)
    Abstract [en]

    n/a

  • 372.
    Walther, Sten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Jonasson, U
    Outcome of the elderly critically ill after intensive care in an era of cost containment2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, p. 417-422Article in journal (Refereed)
  • 373.
    Walther, Sten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiology . Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Jonasson, U
    Karlsson, Susanne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion.
    Nordlund, Per-Johan
    Linköping University, The Institute of Technology. Linköping University, Department of Electrical Engineering.
    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 ICU2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 6, p. 690-696Article in journal (Refereed)
    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.

  • 374.
    Walther, Sten
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nolin, Thomas
    Central Hospital, Kristianstad, Sweden.
    Unexpected gender bias among organ donors in Sweden during 2009-2013. A nationwide observational study.2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no Suppl. 121, article id O13-09Article in journal (Other academic)
    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.

  • 375.
    Wang, J. H.
    et al.
    Beijing Hospital, China.
    He, Q.
    Beijing Hospital, China.
    Liu, Y. L.
    Beijing Hospital, China.
    Hahn, Robert G.
    Södertälje Hospital, Sweden.
    Pulmonary edema in the transurethral resection syndrome induced with mannitol 5%2009In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 8, p. 1094-1096Article in journal (Refereed)
    Abstract [en]

    Two patients developed the transurethral resection (TUR) syndrome after having absorbed mannitol 5% during TUR of the prostate. Both developed pulmonary edema and became severely hypoatremic (lowest serum sodium 99 and 97 mmol/l, respectively). Hypertonic saline was infused to raise the serum sodium level and plasma volume expansion used to combat hypotension. One patient also required positive-pressure ventilation and intravenous administration of norepinephrine. Both patients recovered completely.

  • 376.
    Wang, Jianpu
    et al.
    Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Abu-Zidan, Fikri
    Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Faculty of Health Sciences.
    Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury2002In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, no 9, p. 1094-1102Article in journal (Refereed)
    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.

  • 377.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Winskog, C.
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Edston, Erik
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs2005In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 2, p. 183-190Article in journal (Refereed)
    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.

  • 378.
    Wattwil, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care.
    Thorn, S.-E.
    Thörn, S.-E., Dept. of Anesthiol./Intensive Care, Ctr. Assess. Med. Technol. in Orebro, University Hospital, Örebro, Sweden.
    Lovqvist, A.
    Lövqvist, Å., Dept. of Anesthiol./Intensive Care, Ctr. Assess. Med. Technol. in Orebro, University Hospital, Örebro, Sweden.
    Wattwil, L.
    Dept. of Anesthiol./Intensive Care, Ctr. Assess. Med. Technol. in Orebro, University Hospital, Örebro, Sweden.
    Gupta, A.
    Dept. of Anesthiol./Intensive Care, Ctr. Assess. Med. Technol. in Orebro, University Hospital, Örebro, Sweden.
    Liljegren, G.
    Department of Surgery, Ctr. Assess. Med. Technol. in Orebro, University Hospital, Örebro, Sweden.
    Dexamethasone is as effective as ondansetron for the prevention of postoperative nausea and vomiting following breast surgery2003In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 47, no 7, p. 823-827Article in journal (Refereed)
    Abstract [en]

    Introduction: Postoperative nausea and vomiting remain a common problem following breast surgery. This study assesses whether dexamethasone is as effective as ondansetron in the control of postoperative nausea and vomiting (PONV). Methods: Eighty ASA I-III patients undergoing breast surgery for carcinoma of the breast were included in the study. Following premedication with diazepam 5-10 mg, patients were induced with fentanyl 50 µg and propofol 2-2.5 mg kg-1. A larynx mask was inserted and anesthesia maintained with sevoflurane in oxygen and nitrous oxide. Patients were then randomly divided into two groups: Group D (dexamethasone) was given 4 mg dexamethasone i.v. after induction and Group O (ondansetron) was given 4 mg ondansetron at the same time point. Postoperatively, nausea, vomiting and pain were recorded at 1-h intervals during 4 h, and thereafter every 4h during 24 h. Results: The incidence of PONV during 24h was 37% and 33% in Group D and Group O, respectively (NS). No differences were found between the groups in the incidence of post-operative nausea, vomiting or pain at the different time intervals. No differences were found in the incidence of PONV in smokers vs. non-smokers. No side-effects of these drugs were observed. Conclusions: Ondansetron 4 mg or dexamethasone 4 mg are equally effective in the prevention of postoperative nausea and vomiting following breast surgery. Other factors being similar, the difference in cost between these drugs would favor the use of dexamethasone instead of ondansetron when monotherapy against PONV is used. © Acta Anaesthesiologica Scandinavica.

  • 379.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Adamski, Jan
    Satakunta Dist Hosp, Dept Anaesthesia & Intens Care, Pori, Finland..
    Gorynski, Pawel
    Natl Inst Publ Hlth, Natl Inst Hyg, Ctr Monitoring & Anal Populat Hlth Status, Warsaw, Poland..
    Kanski, Andrzej
    Med Univ Warsaw, Cent Teaching Hosp, Dept Anesthesiol & Intens Care 2, Warsaw, Poland..
    Hultström, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology.
    Comparison of ICU outcomes in Poland to other European countries: reasons for high mortality rates2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1022-1023Article in journal (Other academic)
  • 380.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Bierylo, Andrzej
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Wielgus, Monika
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland.;Gruca Orthoped & Trauma Teaching Hosp, Ctr Postgrad Med Educ, Dept Anesthesiol & Intens Care, Otwock, Poland..
    Krzemien-Wiczynska, Swietlana
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Kolacz, Marcin
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Dabrowski, Michal Jerzy
    Polish Acad Sci, Inst Comp Sci, Warsaw, Poland..
    Peri-operative analgesia with intrathecal opioids for Caesarean section2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1014-1015Article in journal (Other academic)
  • 381.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland..
    Milej, Daniel
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Gerega, Anna
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Toczylowska, Beata
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Sawosz, Piotr
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Kacprzak, Michal
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Janusek, Dariusz
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Wojtkiewicz, Stanislaw
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Maniewski, Roman
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Optical methods based on tracking of optical contrast agent in confirmation of brain death: preliminary results2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 979-980Article in journal (Other academic)
  • 382.
    Wernerman, J.
    et al.
    Karolinska University Hospital.
    Kirketeig, T.
    Karolinska University Hospital.
    Andersson, B.
    Sahlgrens University Hospital.
    Berthelson, H.
    Kristianstad Hospital.
    Ersson, A.
    Skane University Hospital.
    Friberg, H.
    Skane University Hospital.
    Guttormsen, A.B.
    Bergen University Hospital.
    Hendrikx, S.
    Danderyd Hospital.
    Pettila, V.
    Helsinki University Hospital.
    Rossi, P.
    Karolinska University Hospital.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Winso, O.
    Norrland University Hospital.
    Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 7, p. 812-818Article in journal (Refereed)
    Abstract [en]

    Background: Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. Methods: Patients (n = 413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. L-alanyl-L-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for greater than3 days were considered as predetermined per protocol (PP) patients. Results: There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P = 0.792, for the glutamine group and the controls, respectively. Conclusion: In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.

  • 383.
    Wiklund, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Zoerner, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Semenas, Egidijus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Miclescu, Adriana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Sharma, Hari Shanker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Improved neuroprotective effect of methylene blue with hypothermia after porcine cardiac arrest2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1073-1082Article in journal (Refereed)
    Abstract [en]

    Background

    Induced mild hypothermia and administration of methylene blue (MB) have proved to have neuroprotective effects in cardiopulmonary resuscitation (CPR); however, induction of hypothermia takes time. We set out to determine if MB administered during CPR could add to the histologic neuroprotective effect of hypothermia.

    Methods

    A piglet model of extended cardiac arrest (12 min of untreated cardiac arrest and 8 min of CPR) was used to assess possible additional neuroprotective effects of MB when administered during CPR before mild therapeutic hypothermia induced 30 min after restoration of spontaneous circulation (ROSC). Three groups were compared: C group (n = 8) received standard CPR; PH group (n = 8) received standard CPR but 30 min after ROSC these piglets were cooled to 34°C; the PH+MB group (n = 8) received an MB infusion 1 min after commencement of CPR and the same cooling protocol as the PH group. Three hours later, the animals were killed. Immediately after death, the brains were harvested pending histological and immunohistological analysis.

    Results

    Circulatory variables were similar in the groups except that cardiac output was greater in the PH+MB group 2–3 h after ROSC. Cerebral cortical neuronal injury and blood–brain barrier disruption was greatest in the C group and least in the MB group. The neuroprotective effect of MB and hypothermia was significantly greater than that of delayed hypothermia alone.

    Conclusion

    Administration of MB during CPR added to the short term neuroprotective effects of induced mild hypothermia induced 30 min after ROSC.

  • 384.
    Wilhelms, S. B.
    et al.
    Linkoping Univ, Dept Anaesthesia & Intens Care, S-58185 Linkoping, Sweden.; Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Walther, S M
    Linkoping Univ, Dept Cardiothorac Anaesthesia & Intens Care, Linkoping, Sweden.; Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Huss, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Sjöberg, F.
    Linkoping Univ, Dept Anaesthesia & Intens Care, S-58185 Linkoping, Sweden.; Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Severe sepsis in the ICU is often missing in hospital discharge codes2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 2, p. 186-193Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Different International Classification of Diseases (ICD)-based code abstraction strategies have been used when studying the epidemiology of severe sepsis. The aim of this study was to compare three previously used ICD code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis, in a setting of intensive care patients.

    METHODS: All patients (≥ 18 years of age) with severe sepsis according to the ACCP/SCCM criteria registered in the Swedish Intensive Care Registry (2005-2009) were included in the study. Using the Swedish National Patient Register, we investigated whether these patients fulfilled an ICD code compilation for severe sepsis at hospital discharge.

    RESULTS: Overall, 9271 patients with severe sepsis were registered in the Swedish Intensive Care Registry. A majority of these patients (55.4%) were discharged from the hospital with ICD codes that did not correspond to any of the ICD code compilations. A minority of patients (10.3%) were discharged with ICD codes corresponding to all three code abstraction strategies applied. Overall, the proportion of patients discharged with ICD codes corresponding to the criteria of Angus et al. was 15.1%, to the criteria of Flaatten was 39.8%, and to the criteria of Martin et al. was 16.0%.

    CONCLUSIONS: A majority of patients with severe sepsis according to the ACCP/SCCM criteria were not discharged with ICD codes corresponding to the ICD code abstraction strategies; thus, the abstraction strategies did not identify the correct patients.

  • 385.
    Wilhelms, Susanne
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Huss, F.
    Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Severe sepsis in the ICU is often missing in hospital discharge codes.2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Different International Classification of Diseases (ICD)-based code abstraction strategies have been used when studying the epidemiology of severe sepsis. The aim of this study was to compare three previously used ICD code abstraction strategies to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis, in a setting of intensive care patients.

    METHODS: All patients (≥ 18 years of age) with severe sepsis according to the ACCP/SCCM criteria registered in the Swedish Intensive Care Registry (2005-2009) were included in the study. Using the Swedish National Patient Register, we investigated whether these patients fulfilled an ICD code compilation for severe sepsis at hospital discharge.

    RESULTS: Overall, 9271 patients with severe sepsis were registered in the Swedish Intensive Care Registry. A majority of these patients (55.4%) were discharged from the hospital with ICD codes that did not correspond to any of the ICD code compilations. A minority of patients (10.3%) were discharged with ICD codes corresponding to all three code abstraction strategies applied. Overall, the proportion of patients discharged with ICD codes corresponding to the criteria of Angus et al. was 15.1%, to the criteria of Flaatten was 39.8%, and to the criteria of Martin et al. was 16.0%.

    CONCLUSIONS: A majority of patients with severe sepsis according to the ACCP/SCCM criteria were not discharged with ICD codes corresponding to the ICD code abstraction strategies; thus, the abstraction strategies did not identify the correct patients.

  • 386.
    Wilhelms, Susanne
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    de Geer, Lina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Causes of late mortality among ICU-treated patients with sepsis2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    Background Patients with sepsis may have an increased risk of late mortality, but the causes of late death are unclear. This retrospective matched cohort study aimed to determine the causes of late death (&gt;= 1 year) among patients with sepsis compared to patients without sepsis. Methods 8760 patients with severe sepsis or septic shock (2001 consensus criteria) registered in the Swedish Intensive Care Registry (2008-2013) were compared with a 1:1 matched (gender, age, SAPS3 probability for death, ICU length of stay) control group consisting of non-septic ICU patients. Causes of death (International Classification of Diseases codes) were obtained from the Swedish Cause of Death Register (2008-2014). Results During 2008-2014, 903 patients with sepsis died at &gt;= 365 days after their initial septic event, compared to 884 patients in the control group. Median time of follow-up was 313 days (sepsis group, interquartile range 11-838 days) vs 288 days (control group, 9-836 days). The most common causes of death were heart diseases (sepsis: 50.2%, non-septic: 48.6%) and cancer (sepsis: 33.7%, non-septic: 31.7%). Infectious diseases were significantly more common cause of death in the sepsis group (24.3% vs 19.6%, respectively; P &lt; .05). Pneumonia was a common infectious cause of death in both groups, whereas sepsis was more common in the sepsis group. Conclusions The most common causes of late death after ICU admission among patients with and without sepsis were heart diseases and cancer. However, patients with sepsis more frequently had infectious diseases as a cause of late death, compared to non-septic patients.

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  • 387.
    Zdolsek, Joachim
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Letter: Allergic reaction after dextran In response2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 1, p. 132-133Article in journal (Other academic)
    Abstract [en]

    n/a

  • 388.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Vrinnevi Hospital, Sweden.
    Bergek, Christian
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Sodertalje Hospital, Sweden.
    Colloid osmotic pressure and extravasation of plasma proteins following infusion of Ringers acetate and hydroxyethyl starch 130/0.42015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1303-1310Article in journal (Refereed)
    Abstract [en]

    BackgroundDuring fluid infusion therapy, plasma proteins are diluted and leak from the intravascular space, which alters the colloid osmotic pressure (COP) and potentially affects coagulation. We hypothesised that acetated Ringers and starch solution, alone or in combination, influence these mechanisms differently. Materials and methodsOn different occasions, 10 male volunteers were infused with 20ml/kg acetated Ringers and 10ml/kg 6% hyroxyethyl starch 130/0.4 (Voluven((R))) alone or in combination (first with starch solution followed by Ringers solution). Blood samples were collected every 30-min for measurements of COP, blood haemoglobin, platelets, and plasma concentrations of albumin, immunoglobulins (IgG and IgM), coagulation factor VII (FVII), fibrinogen, cystatin C, activated partial thromboplastin time (APTT) and prothrombin international normalised ratio (PT-INR). Changes were compared with the haemoglobin-derived plasma dilution. ResultsThe COP increased by 8.4% (SD 3) with starch and decreased by 26.2% (7.9) with Ringers. These infusions diluted the plasma by 23.4% (5.3) and 18.7% (4.9) respectively. The COP changes in the combined experiment followed the same pattern as the individual infusions. Albumin and IgG changes in excess of the plasma dilution were very subtle. The intravascular contents of the IgM and platelets decreased, whereas FVII, fibrinogen and cystatin C increased. PT-INR increased by 1/3 of the plasma dilution, whereas changes in APTT did not correlate with the plasma dilution. ConclusionsThe starch increased COP and only minor capillary leak occurred in healthy volunteers. The fluid-induced plasma dilution correlated with mild impairment of the extrinsic coagulation pathway but not of the intrinsic pathway.

  • 389.
    Zdolsek, Joachim
    et al.
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Holmgren, Susanna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics.
    Wedenberg, K
    Department of Obstetrics and Gynaecology, Eskilstuna, Sweden.
    Lennmarken, Claes
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Circulatory arrest in late pregnancy: caesarean section a vital decision for both mother and child2009In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 53, no 6, p. 828-829Article in journal (Refereed)
    Abstract [en]

    Circulatory arrest during pregnancy is extremely rare and there should be a well-planned strategy for its management in all hospitals. To consider the priority of the mothers life over the childs and an unwarranted pre-term delivery may lead to hesitancy and uncertainty and jeopardize both of them. In these situations, speed is a priority. Cardiopulmonary resuscitation should commence immediately. The anaesthesiologist should be well aware of the possible advantage of a caesarean section. Even if the obstetrician is responsible for the decision to perform the operation, the anaesthesiologist should strongly support the action. An emergency caesarean kit with the essential surgical instruments should be immediately available in every labour ward and emergency department.

  • 390.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
    Vegfors, Magnus
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Chemistry.
    Tornquist, T.
    Regional Hospital Motala.
    Bortnik, P.
    Regional Hospital Motala.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Hydroxyethyl starches and dextran during hip replacement surgery: effects on blood volume and coagulation2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 6, p. 677-685Article in journal (Refereed)
    Abstract [en]

    Background: Colloid fluids influence the coagulation system by diluting the plasma and, potentially, by exerting other effects that are unique for each fluid product. We hypothesised that changes in the coagulation measured at the end of surgery would be mainly governed by differences in half-life between the colloid fluids. Methods: Eighty-four patients were randomised to receive one of four colloids: HES 130/0.42/6 : 1 (Venofundin (R)), 130/0.4/9 : 1 (Voluven (R)), 200/0.5/5 : 1 (Haes-steril (R)) and 6% dextran 70 (Macrodex (R)). Blood samples were taken just before and after a preoperative 500ml bolus, and also after subsequent elective hip replacement surgery. Volume expansion was estimated from the blood dilution and coagulation assessed by ROTEM, activated partial thromboplastin time, prothrombin international normalised ratio (PT-INR), D-dimer and thrombin-antithrombin complex (TAT). Results: The blood volume expansion amounted to approximately 600 ml for all four colloids directly after infusion. Voluven (R) and Haes-steril (R) prolonged the aPT time and Venofundin (R) increased TAT. Although all colloids increased PT-INR and D-dimer, the ROTEM analyses showed that they consistently shortened the clotting time and weakened the clot strength. These effects were mainly unchanged after surgery, during which the haemorrhage averaged 500-600 ml. Macrodex (R) produced a stronger volume support at the end of the surgery (91% of infused volume; Pless than0.001) than the three starch solutions (42-60%). Conclusions: All tested colloid fluids induced a mild hypercoagulable state with faster clotting, but with weaker clot strength. The additive influence of surgery was relatively small, and postoperative changes in coagulation were mainly due to differences in the half-life of each colloid.

  • 391.
    Zdolsek, Markus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland.
    Hahn, R. G.
    Sodertalje Hosp, Sweden; Karolinska Inst, Sweden.
    Zdolsek, Joachim
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Recruitment of extravascular fluid by hyperoncotic albumin2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 9, p. 1255-1260Article in journal (Refereed)
    Abstract [en]

    BackgroundAlthough hyperoncotic albumin may be used to recruit oedema, its effectiveness remains unclear. Therefore, this issue was studied during infusion experiments in healthy volunteers. MethodFifteen healthy volunteers (mean age 31years) received an infusion of 3mL/kg of 20% albumin over 30minutes. Their urinary excretion was recorded, and venous blood samples were taken to measure blood haemoglobin (Hb), haematocrit, colloid osmotic pressure as well as plasma albumin and sodium concentrations on 15 occasions over a period of 300minutes. Plasma volume expansion was taken as the inverse of the fluid-induced dilution of venous plasma, as given by the blood Hb concentration. Mass balance calculations were used to estimate the mobilisation of fluid from the tissues. ResultsMaximum plasma volume expansion was reached 20minutes after completing an infusion of 20% albumin. Urinary excretion was effectively increased, and the mobilised fluid from the tissues at 300minutes amounted to 3.41.2mL for each infused mL of 20% albumin, of which 19% was of intracellular origin. The urinary excretion correlated strongly with the amount of recruited fluid (R-2=0.87) and inversely with the plasma volume expansion (R-2=0.53). ConclusionThe infusion of 20% albumin significantly increases the plasma volume by recruiting interstitial fluid. After completing the infusion, there is a delay of 20minutes until maximum plasma dilution is reached, and the duration of the plasma volume expansion lasts far beyond 5hours.

  • 392.
    Zetterqvist, Vendela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Behavioural Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden.
    Holmström, L.
    Karolinska Univ Hosp, Behav Med Pain Treatment Serv, P8b 01, S-17176 Stockholm, Sweden;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Maathz, Pernilla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Behavioural Medicine Pain Treatment Services, Karolinska University Hospital, Stockholm, Sweden.
    Wicksell, R. K.
    Karolinska Univ Hosp, Behav Med Pain Treatment Serv, P8b 01, S-17176 Stockholm, Sweden;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Pain avoidance predicts disability and depressive symptoms three years later in individuals with whiplash complaints2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 4, p. 445-455Article in journal (Refereed)
    Abstract [en]

    Background Longstanding symptoms due to whiplash are commonly associated with decreased levels of emotional and physical functioning. To date, there is strong empirical support for the relationship between psychological in/flexibility and pain-related functioning, but the predictive role for future health is largely unknown. Hence, the aim of this study was to investigate if psychological in/flexibility (i.e. avoidance and cognitive fusion) predicted pain disability and depressive symptoms 3 years later in individuals with whiplash complaints. Methods Data were collected at baseline and at a 3 year follow-up from 368 members of a national patient organization for people with whiplash-associated disorder. In a series of hierarchical regression analyses, background variables, pain related variables, psychological distress and psychological inflexibility at baseline were evaluated as predictors of levels of pain disability and depressive symptoms at follow-up. Results Results showed that psychological inflexibility, and more specifically avoidance, was a unique predictor of pain disability and depressive symptoms, also when controlling for background variables, pain related variables and psychological distress. Level of education was also found to predict both pain disability and symptoms of depression. Lastly, pain variability predicted pain disability, and anxiety predicted depressive symptoms. Conclusion Pain avoidance significantly predicted pain disability and depressive symptoms 3 years later. Although tentative, results warrant more studies to further explore the importance of pain avoidance for future health.

  • 393.
    Zickerman, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Hult, Ann-Catrin
    Umeå University.
    Hedlund, Lars
    Umeå University.
    Winsö, Ola
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Midazolam is better than clonidine in preventing negative postoperative behaviour in children age 2-42017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 976-977Article in journal (Other academic)
  • 394.
    Zoerner, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Lennmyr, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Martijn, Cécile
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC.
    Semenas, Egidijus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Milrinone and esmolol decrease cardiac damage after resuscitation from prolonged cardiac arrest2015In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 4, p. 465-474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long-term survival after cardiac arrest (CA) due to shock-refractory ventricular fibrillation (VF) is low. Clearly, there is a need for new pharmacological interventions in the setting of cardiopulmonary resuscitation (CPR) to improve outcome. Here, hemodynamic parameters and cardiac damage are compared between the treatment group (milrinone, esmolol and vasopressin) and controls (vasopressin only) during resuscitation from prolonged CA in piglets.

    METHODS: A total of 26 immature male piglets were subjected to 12-min VF followed by 8-min CPR. The treatment group (n = 13) received i.v. (intravenous) boluses vasopressin 0.4 U/kg, esmolol 250 μg/kg and milrinone 25 μg/kg after 13 min, followed by i.v. boluses esmolol 375 μg/kg and milrinone 25 μg/kg after 18 min and continuous esmolol 15 μg/kg/h infusion during 180 min reperfusion, whereas controls (n = 13) received equal amounts of vasopressin and saline. A 200 J monophasic counter-shock was delivered to achieve resumption of spontaneous circulation (ROSC) after 8 min CPR. If ROSC was not achieved, another 200 J defibrillation and bolus vasopressin 0.4 U/kg would be administered in both groups. Direct current shocks at 360 J were applied as one shot per minute over maximally 5 min. Hemodynamic variables and troponin I as a marker of cardiac injury were recorded.

    RESULTS: Troponin I levels after 180 min reperfusion were lower in the treatment group than in controls (P < 0.05). The treatment group received less norepinephrine (P < 0.01) and had greater diuresis (P < 0.01). There was no difference in survival between groups.

    CONCLUSION: The combination of milrinone, esmolol and vasopressin decreased cardiac injury compared with vasopressin alone.

  • 395. Åberg, A. M.
    et al.
    Ahlström, K.
    Abrahamsson, P.
    Waldenström, A.
    Ronquist, G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Hauck, P.
    Johansson, G.
    Biber, B.
    Haney, M.
    Ischaemic pre-conditioning means an increased adenosine metabolism with decreased glycolytic flow in ischaemic pig myocardium2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 10, p. 1257-1264Article in journal (Refereed)
    Abstract [en]

    Background Ischaemic pre-conditioning (IP) is a potent protective mechanism for limiting the myocardial damage due to ischaemia. It is not fully known as to how IP protects. The metabolism of adenosine may be an important mechanistic component. We study the role of adenosine turnover together with glycolytic flow in ischaemic myocardium subjected to IP. Methods An acute myocardial ischaemia pig model was used, with microdialysis sampling of some metabolites (lactate, adenosine, glucose, glycerol, taurine) of ischaemic myocardium. An IP group was compared with a control group before and during a prolonged ischaemia. 14C-labelled adenosine and glucose were infused through microdialysis probes, and lactate, 14C-labelled lactate, glucose, taurine and glycerol were analysed in the effluent. The glycogen content in myocardial biopsies was determined. Results The 14C-adenosine metabolism was higher as there was a higher production of 14C-lactate in IP animals compared with the controls. The glycolytic flow, measured as myocardial lactate formation, was retarded during prolonged ischaemia in IP animals. Myocardial free glucose and glycogen content decreased during the prolonged ischaemia in both groups, with higher free glucose in the IP group. We confirmed the protective effects of IP with lower myocardial concentrations of markers for cellular damage (glycerol). Conclusions This association between increased adenosine turnover and decreased glycolytic flow during prolonged ischaemia in response to IP can possibly be explained by the competitive effect for the metabolites from both glucose and adenosine metabolism for entering glycolysis. We conclude that this study provides support for an energy-metabolic explanation for the protective mechanisms of IP.

  • 396.
    Åberg, Anna-Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Ahlström, K
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Abrahamsson, Pernilla
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Waldenström, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ronquist, Gunnar
    Department of Medical Sciences, Clinical Chemistry, University Hospital of Uppsala, Uppsala, Sweden.
    Hauck, Philip
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Johansson, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Biber, B
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Ischaemic pre-conditioning means an increased adenosine metabolism with decreased glycolytic flow in ischaemic pig myocardium2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 10, p. 1257-1264Article in journal (Refereed)
    Abstract [en]

    This association between increased adenosine turnover and decreased glycolytic flow during prolonged ischaemia in response to IP can possibly be explained by the competitive effect for the metabolites from both glucose and adenosine metabolism for entering glycolysis. We conclude that this study provides support for an energy-metabolic explanation for the protective mechanisms of IP.

  • 397. Åneman, A.
    et al.
    Mellin-Olsen, J.
    Søreide, E.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    The future role of the Scandinavian anaesthesiologist: a web-based survey2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 9, p. 1071-1076Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Board of the Scandinavian Society for Anaesthesiology and Intensive Care Medicine (SSAI) decided in 2008 to undertake a survey among members of the SSAI aiming at exploring some key points of training, professional activities and definitions of the specialty.

    METHODS: A web-based questionnaire was used to capture core data on workforce demographics and working patterns together with opinions on definitions for practice/practitioners in the four areas of anaesthesia, intensive care medicine, emergency medicine and pain medicine.

    RESULTS: One thousand seven hundred and four responses were lodged, representing close to half of the total SSAI membership. The majority of participants reported in excess of 10 years of professional experience in general anaesthesia and intensive care medicine as well as emergency and pain medicine. While no support for separate or secondary specialities in the four areas was reported, a majority of respondents favoured sub-specialisation or recognition of particular medical competencies, notably so for intensive care medicine. Seventy-five percent or more of the respondents supported a common framework of employment within all four areas irrespective of further specialisation.

    CONCLUSIONS: The future of Scandinavian anaesthesiology is likely to involve further specialisation towards particular medical competencies. With such diversification of the workforce, the majority of the respondents still acknowledge the importance of belonging to one organisational body.

  • 398.
    Örman, J.
    et al.
    Department of Intensive Care, Linköping University Hospital, Linköping, Sweden.
    Westerdahl, Elisabeth
    Örebro University, School of Health and Medical Sciences. Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, Uppsala, Sweden; Department of Physiotherapy and Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 3, p. 261-267Article in journal (Refereed)
    Abstract [en]

    A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic surgery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment.

  • 399.
    Örman, Jenny
    et al.
    Linköping University Hospital.
    Westerdahl, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 3, p. 261-267Article, review/survey (Refereed)
    Abstract [en]

    A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic surgery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment.

  • 400.
    Österlind, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Gerhardsson, Jakob
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Myrberg, Tomi
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Critical Care Transition Programs on Readmission or Death: A Systematic Review and Meta-Analysis2020In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article, review/survey (Refereed)
    Abstract [en]

    Background: Deterioration after ICU discharge may lead to readmission or even death. Interventions (e.g. critical care transition programs) have been developed to improve the clinical handover between the ICU and ward. We conducted a systematic review with meta‐analysis and trial sequential analysis (TSA) according to Cochrane Handbook and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to assessthe impact of these interventions on readmission and death (PROSPERO, no CRD42019121746).

    Methods: We searched PubMed/MEDLINE, CINAHL, AMED, PsycINFO and the Cochrane Central Register for Controlled Trials from inception until January 2019. We included historically controlled studies that evaluated critical care transition programs in adults discharged from the ICU. Readmission and in‐hospital mortality were the primary outcomes. Risk of bias, publications bias and the quality of evidence were assessed with the ROBINS‐I tool, funnel plot and GRADE, respectively.

    Results: Fifteen observational studies were included (11 in meta‐analysis). All studies had at least serious risk of bias. ICU discharge within a critical care transition program modestly reduced the risk of readmission (RR 0.78; 95% CI: 0.64 to 0.96; TSA‐adjusted 95% CI: 0.59 to 1.03) but not in‐hospital mortality (RR 0.82; 95% CI: 0.64 to 1.06; TSA‐adjusted 95% CI: 0.49 to 1.37). There was substantial heterogeneity among studies. TSA indicated lack of firm evidence. The GRADE quality of evidence on outcomes was very low.

    Conclusions: We found no clear benefit in terms of reducing risk of readmission or death after ICU discharge,however with overall very low certainty of evidence.

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