| 1. |
|
|
| 2. |
- Cavefors, Oscar, et al.
(författare)
-
Isolated diastolic dysfunction is associated with increased mortality in critically ill patients.
- 2023
-
Ingår i: Journal of critical care. - : Elsevier BV. - 1557-8615 .- 0883-9441. ; 76
-
Tidskriftsartikel (refereegranskat)abstract
- Left ventricular (LV) diastolic dysfunction is important in critically ill patients, but prevalence and impact on mortality is not well studied. We classified intensive care patients with normal left ventricular function according to current diastolic guidelines and explored associations with mortality.Echocardiography was performed within 24h of intensive care admission. Patients with reduced LV ejection fraction, regional wall motion abnormality, or a history of cardiac disease were excluded. Patients were classified according to the 2016 EACVI guidelines, Recommendations for the Evaluation of LV Diastolic Function by Echocardiography.Out of 218 patients, 162 (74%) had normal diastolic function, 21 (10%) had diastolic dysfunction, and 35 (17%) had indeterminate diastolic function. Diastolic dysfunction were more common in female patients, older patients and associated with sepsis, respiratory and cardiovascular comorbidity as well as higher SAPS Score. In a risk-adjusted logistic regression model, patients with indeterminate diastolic dysfunction (OR 4.3 [1.6-11.4], p=0.004) or diastolic dysfunction (OR 5.1 [1.6-16.5], p=0.006) had an increased risk of death at 90days compared to patients with normal diastolic function.Isolated diastolic dysfunction, assessed by a multi-parameter approach, is common in critically ill patients and is associated with mortality.Secondary analysis of data from a single-center prospective observational study focused on systolic dysfunction in intensive care unit patients (Clinical Trials ID: NCT03787810.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Lundin, Andreas, et al.
(författare)
-
Veno-arterial CO2 difference and respiratory quotient after cardiac arrest: An observational cohort study.
- 2021
-
Ingår i: Journal of critical care. - : Elsevier BV. - 1557-8615 .- 0883-9441. ; 62:April, s. 131-137
-
Tidskriftsartikel (refereegranskat)abstract
- To characterize venous-arterial CO2 difference (ΔpCO2) and the respiratory quotient (RQ) in post cardiac arrest patients and evaluate the association between these parameters and patient outcome.Data were obtained retrospectively from post cardiac arrest patients admitted between 2007 and 2016 to a medical intensive care unit. Comatose, adult patients in whom arterial and venous blood gas analyses were concomitantly performed in the first 24h were included. Patients were grouped according to the time-point of sampling; 0-6, 6-12 and 12-24h after admission.308 patients were included; 174 (56%) died before ICU discharge and 212 (69%) had an unfavorable neurologic outcome. RQ was associated with ICU mortality (OR:1.09 (95%CI: 1.04-1.14; p<0.01)), although not with neurological outcome. ΔpCO2 was negatively associated with both ICU mortality (OR: 0.92 (95%CI: 0.86-0.99; p=0.02)) and poor neurologic outcome (adjusted OR: 0.93 (95%CI: 0.87-0.99; p=0.02)). ΔpCO2 predicted an elevated RQ; a ΔpCO2 above 8.5mmHg identified a high RQ with reasonable sensitivity and specificity.RQ was associated with ICU mortality and ΔpCO2 identified elevated RQ in the early phase after cardiac arrest. However, ΔpCO2 were negatively associated with both ICU mortality and neurologic outcome.
|
|
| 6. |
- Orwelius, Lotti, et al.
(författare)
-
Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up
- 2024
-
Ingår i: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 80
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival). Methods: Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression. Results: We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge. Conclusions: Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.
|
|
| 7. |
- Persson, Inger, et al.
(författare)
-
Early prediction of sepsis in intensive care patients using the machine learning algorithm NAVOY® Sepsis, a prospective randomized clinical validation study
- 2024
-
Ingår i: Journal of critical care. - : Elsevier. - 0883-9441 .- 1557-8615. ; 80
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose:To prospectively validate, in an ICU setting, the prognostic accuracy of the sepsis prediction algorithm NAVOY® Sepsis which uses 4 h of input for routinely collected vital parameters, blood gas values, and lab values.Materials and methods:Patients 18 years or older admitted to the ICU at Skåne University Hospital Malmö from December 2020 to September 2021 were recruited in the study. A total of 304 patients were randomized into one of two groups: Algorithm group with active sepsis alerts, or Standard of care. NAVOY® Sepsis made silent predictions in the Standard of care group, in order to evaluate its performance without disturbing the outcome. The study was blinded, i.e., study personnel did not know to which group patients were randomized. The healthcare provider followed standard practices in assessing possible development of sepsis and intervening accordingly. The patients were followed-up in the study until ICU discharge. Results:NAVOY® Sepsis could predict the development of sepsis, according to the Sepsis-3 criteria, three hours before sepsis onset with high performance: accuracy 0.79; sensitivity 0.80; and specificity 0.78.Conclusions:The accuracy, sensitivity, and specificity were all high, validating the prognostic accuracy of NAVOY® Sepsis in an ICU setting, including Covid-19 patients.
|
|
| 8. |
|
|
| 9. |
- Stattin, Karl, et al.
(författare)
-
Inadequate prophylactic effect of low-molecular weight heparin in critically ill COVID-19 patients
- 2020
-
Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441 .- 1557-8615. ; 60, s. 249-252
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to investigate potential markers of coagulopathy and the effects of thromboprophylaxis with low-molecular-weight heparin (LMWH) on thromboelastography (TEG) and anti-factor Xa in critically ill COVID-19 patients.MATERIAL AND METHODS: We conducted a prospective study in 31 consecutive adult intensive care unit (ICU) patients. TEG with and without heparinase and anti-factor Xa analysis were performed. Standard thromboprophylaxis was given with dalteparin (75-100 IU/kg subcutaneously).RESULTS: Five patients (16%) had symptomatic thromboembolic events. All patients had a maximum amplitude (MA) > 65 mm and 13 (42%) had MA > 72 mm at some point during ICU stay. Anti-factor Xa activity were below the target range in 23% of the patients and above target range in 46% of patients. There was no significant correlation between dalteparin dose and anti-factor Xa activity.CONCLUSIONS: Patients with COVID-19 have hypercoagulability with high MA on TEG. The effect of LMWH on thromboembolic disease, anti-factor Xa activity and TEG was variable and could not be reliably predicted. This indicates that standard prophylactic doses of LMWH may be insufficient. Monitoring coagulation and the LMWH effect is important in patients with COVID-19 but interpreting the results in relation to risk of thromboembolic disease poses difficulties.
|
|
| 10. |
- Svedung Wettervik, Teodor, et al.
(författare)
-
Arterial lactate in traumatic brain injury : Relation to intracranial pressure dynamics, cerebral energy metabolism and clinical outcome
- 2020
-
Ingår i: Journal of critical care. - : Elsevier BV. - 0883-9441 .- 1557-8615. ; 60, s. 218-225
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: High arterial lactate is associated with disturbed systemic physiology. Lactate can also be used asalternative cerebral fuel and it is involved in regulating cerebral blood flow. This study explored the relation ofendogenous arterial lactate to systemic physiology, pressure autoregulation, cerebral energy metabolism, andclinical outcome in traumatic brain injury (TBI).Method: A retrospective study including 115 patients (consent given) with severe TBI treated in the neurointensivecare unit, Uppsala university hospital, Sweden, 2008–2018. Data from cerebral microdialysis, arterialblood gases, hemodynamics and intracranial pressure were analyzed the first ten days post-injury.Results: Arterial lactate peaked on day 1 post-injury (mean 1.7 ± 0.7 mM) and gradually decreased. Higherarterial lactate correlated with lower age (p-value < 0.05), higher Marshall score (p-value < 0.05) andhigher arterial glucose (p-value < 0.001) in a multiple regression analysis. Higher arterial lactate was associatedwith poor pressure autoregulation (p-value < 0.01), but not to worse cerebral energy metabolism.Higher arterial lactate was also associated with unfavorable clinical outcome (p-value < 0.05).Conclusions: High endogenous arterial lactate is a biomarker of poor systemic physiology and may disturbcerebral blood flow autoregulation.
|
|
