| 1. |
- Berkius, Johan, et al.
(författare)
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Long-term survival according to ventilation mode in acute respiratory failure secondary to chronic obstructive pulmonary disease: A multicenter, inception cohort study
- 2010
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Ingår i: JOURNAL OF CRITICAL CARE. - : Elsevier Science B. V., Amsterdam. - 0883-9441 .- 1557-8615. ; 25:3
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the study was to investigate 5-year survival stratified by mechanical ventilation modality in chronic obstructive pulmonary disease (COPD) patients treated in the ICU. Materials and Methods: Prospective, observational study of COPD patients with acute respiratory failure admitted to 9 multidisciplinary ICUs in Sweden. Characteristics on admission, including illness severity scores and the first blood gas, and survival were analyzed stratified by ventilation modality (noninvasive [NIV] vs invasive mechanical ventilation). Results: Ninety-three patients, mean age of 70.6 (SD, 9.6) years, were included. Sixteen patients were intubated immediately, whereas 77 were started on NIV. Patients who were started on NIV had a lower median body mass index (BMI) (21.9 vs 27.0; P andlt; .01) and were younger compared to those who were intubated immediately (median age, 70 vs 74.5 years; P andlt; .05). There were no differences in the initial blood gas results between the groups. Long-term survival was greater in patients with NIV (P andlt; .05, log rank). The effect of NIV on survival remained after including age, Acute Physiology and Chronic Health Evaluation II score, and BMI in a multivariate Cox regression model (NIV hazard ratio, 0.44; 95% confidence interval, 0.21-0.92). Fifteen patients with failed NIV were intubated and mechanically ventilated. Long-term survival in patients with failed NIV was not significantly different from patients who were intubated immediately. Conclusion: The short-term survival benefit of NIV previously found in randomized controlled trials still applies after 5 years of observation.
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| 2. |
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| 3. |
- Lipcsey, Miklos, et al.
(författare)
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Clinically manifest thromboembolic complications of femoral vein catheterization for continuous renal replacement therapy
- 2014
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Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441 .- 1557-8615. ; 29:1, s. 18-23
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:The safety of femoral vein (FV) catheterization for continuous renal replacement therapy is uncertain. We sought to determine the incidence of clinically manifest venous thromboembolism (VTE) in such patients.METHODS:We retrospectively studied patients with femoral high flow catheters (≥13F) (December 2005 to February 2011). Discharge diagnostic codes were independently screened for VTE. The incidence of VTE was also independently similarly assessed in a control cohort of patients ventilated for more than 2 days (January 2011 to December 2011) in the same intensive care unit (ICU).RESULTS:We studied 380 patients. Their mean age was 61 years, and 59% were male. The mean Acute Physiology and Chronic Health Evaluation III score was 84; average duration of continuous renal replacement therapy was 74 hours, and 232 patients (61%) survived to hospital discharge with an average length of hospital stay of 22 days. Only 5 patients (1.3%) had clinically manifest VTE after FV catheterization. In the control cohort of 514 ICU patients, the incidence of VTE was 4.4% (P < .05 compared with FV group).CONCLUSION:The incidence of clinically manifest VTE after FV catheterization with high flow catheters is low and lower to that seen in general ICU patients.
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| 4. |
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| 5. |
- Schneider, Antoine G, et al.
(författare)
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Simple translational equations to compare illness severity scores in intensive care trials
- 2013
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Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441 .- 1557-8615. ; 28:5, s. 885.e1-
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:Comparison of illness severity for intensive care unit populations assessed according to different scoring systems should increase our ability to compare and meta-analyze past and future trials but is currently not possible. Accordingly, we aimed to establish a methodology to translate illness severity scores obtained from one system into another.MATERIALS AND METHODS:Using the Australian and New-Zealand intensive care adult patient database, we obtained simultaneous admission Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III scores and Simplified Acute Physiology Score (SAPS) II in 634428 patients admitted to 153 units between 2001 and 2010. We applied linear regression analyses to create models enabling translation of one score into another. Sensitivity analyses were performed after removal of diagnostic categories excluded from the original APACHE database, after matching for similar risk of death, after splitting data according to country of origin (Australia or New Zealand) and after splitting admissions occurring before or after 2006.RESULTS:The translational models were APACHE III = 3.08 × APACHE II + 5.75; APACHE III = 1.47 × SAPS II + 8.6; and APACHE II = 0.36 × SAPS II + 4.4. The area under the receiver operating curve for mortality prediction was 0.853 (95% confidence interval, 0.851-0.855) for the "APACHE II derived APACHE III" score and 0.854 (0.852-0.855) for the "SAPS II derived APACHE III" vs 0.854 (0.852-0.855) for the original APACHE III score. Similarly, it was 0.841 (0.839-0.843) for the "SAPS II derived APACHE II score" vs 0.842 (0.840-0.843) for the original APACHE II score. Correlation coefficients as well as intercepts remained very similar in all subgroups analyses.CONCLUSIONS:Simple and robust translational formulas can be developed to allow clinicians to compare illness severity between studies involving critically ill patients. Further studies in other countries and health care systems are needed to confirm the generalizability of these results.
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| 6. |
- Suzuki, Satoshi, et al.
(författare)
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Pulse pressure variation-guided fluid therapy after cardiac surgery : A pilot before-and-after trial
- 2014
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Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441 .- 1557-8615. ; 29:6, s. 992-996
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery. Materials and methods: We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV >= 13% for at least >10 minutes during the intervention period. Results: We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL[interquartile range 549-1968] vs 1481 mL [807-2563]; P =. 17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P = .004) but not during the first 24 hours (P = .47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted. Conclusions: Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small.
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| 7. |
- Oltean, Simona, et al.
(författare)
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Charlson's weighted index of comorbidities is useful in assessing the risk of death in septic patients.
- 2012
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Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441. ; 27:4, s. 370-375
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We investigated the efficiency of the Charlson's weighted index of comorbidities (WIC) in predicting the risk of death in septic patients. MATERIALS AND METHODS: A single-center, 3-year analysis of all septic patients was conducted; WIC and organ failure assessed using the Sepsis-related Organ Failure Assessment (SOFA) score were calculated retrospectively. RESULTS: Of 250 septic patients, 60 patients (34%) had WIC above 2. Fifty-five patients (22%) died during the hospitalization. Increasing WIC was associated with increased mortality. Mean WIC differed significantly between survivors and nonsurvivors (P < .0001), and the univariate logistic regression revealed that risk of death depends significantly of WIC with odds ratio of 1.59 (95% confidence interval, 1.31-1.93; P < .001). The accuracy of prediction for the risk of death was 79.2%. Receiver operating characteristics curve indicated a WIC of 2 as a cutoff value, the association between WIC greater than 2, and the risk of death being described by an odds ratio of 1.87 (95% confidence interval, 1.017-3.457; P = .042); the area under the receiver operating characteristics curve in predicting mortality was 0.81 for the SOFA score and 0.68 for WIC; WIC correlated positively with SOFA (r = 0.27; P < .0001). CONCLUSION: In septic patients, WIC is predictive for hospital mortality, and the risk of death significantly depends on WIC.
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| 8. |
- Ragnarsdottir, K. V., et al.
(författare)
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Challenging the planetary boundaries I: Basic principles of an integrated model for phosphorous supply dynamics and global population size
- 2011
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Ingår i: Applied Geochemistry. - : Elsevier BV. - 0883-2927. ; 26:Suppl., s. 303-306
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Tidskriftsartikel (refereegranskat)abstract
- A simple mass balance model has been developed to assess the planetary boundary for P supply in relation to use by human society. Phosphorus sources used by humans are from fossil reserves. The model takes into account resource use rate and reserves, consumption, phosphate to food production, environmental degradation, waste and recycling. Various policy scenarios are tested from current end of pipe solutions to clean production and pollution prevention, sustainable consumption and production polices and sustainable population policy. In order to get an overview of possible future scenarios it is necessary to close nutrient cycles and formulate a sustainable population policy. The outcome of systems dynamics based modeling for four scenarios are given in a sister paper in this issue. Results show that effective population and P recycling policies are crucial to avoid world hunger. (C) 2011 Elsevier Ltd. All rights reserved.
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