| 41. |
- Granholm, Anders, et al.
(författare)
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Higher vs Lower Doses of Dexamethasone in Patients with COVID-19 and Severe Hypoxia (COVID STEROID 2) trial: Protocol for a secondary Bayesian analysis
- 2021
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 65:5, s. 702-710
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Tidskriftsartikel (refereegranskat)abstract
- Background Coronavirus disease 2019 (COVID-19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID-19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs lower doses of dexamethasone (12 vs 6 mg intravenously daily for up to 10 days) in 1,000 adult patients with COVID-19 and severe hypoxia. Methods This protocol outlines the rationale and statistical methods for a secondary, pre-planned Bayesian analysis of the primary outcome (days alive without life support at day 28) and all secondary outcomes registered up to day 90. We will use hurdle-negative binomial models to estimate the mean number of days alive without life support in each group and present results as mean differences and incidence rate ratios with 95% credibility intervals (CrIs). Additional count outcomes will be analysed similarly and binary outcomes will be analysed using logistic regression models with results presented as probabilities, relative risks and risk differences with 95% CrIs. We will present probabilities of any benefit/harm, clinically important benefit/harm and probabilities of effects smaller than pre-defined clinically minimally important differences for all outcomes analysed. Analyses will be adjusted for stratification variables and conducted using weakly informative priors supplemented by sensitivity analyses using sceptic priors. Discussion This secondary, pre-planned Bayesian analysis will supplement the primary, conventional analysis and may help clinicians, researchers and policymakers interpret the results of the COVID STEROID 2 trial while avoiding arbitrarily dichotomised interpretations of the results. Trial registration ClinicalTrials.gov: NCT04509973; EudraCT: 2020-003363-25.
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| 44. |
- Krag, M., et al.
(författare)
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Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries
- 2015
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 59:5, s. 576-585
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stress ulcer prophylaxis (SUP) may decrease the incidence of gastrointestinal bleeding in patients in the intensive care unit (ICU), but the risk of infection may be increased. In this study, we aimed to describe SUP practices in adult ICUs. We hypothesised that patient selection for SUP varies both within and between countries. MethodsAdult ICUs were invited to participate in the survey. We registered country, type of hospital, type and size of ICU, preferred SUP agent, presence of local guideline, reported indications for SUP, criteria for discontinuing SUP, and concerns about adverse effects. Fisher's exact test was used to assess differences between groups. ResultsNinety-seven adult ICUs in 11 countries participated (eight European). All but one ICU used SUP, and 64% (62/97) reported having a guideline for the use of SUP. Proton pump inhibitors were the most common SUP agent, used in 66% of ICUs (64/97), and H2-receptor antagonists were used 31% (30/97) of the units. Twenty-three different indications for SUP were reported, the most frequent being mechanical ventilation. All patients were prescribed SUP in 26% (25/97) of the ICUs. Adequate enteral feeding was the most frequent reason for discontinuing SUP, but 19% (18/97) continued SUP upon ICU discharge. The majority expressed concern about nosocomial pneumonia and Clostridium difficile infection with the use of SUP. ConclusionsIn this international survey, most participating ICUs reported using SUP, primarily proton pump inhibitors, but many did not have a guideline; indications varied considerably and concern existed about infectious complications.
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- Moros, Matthias, et al.
(författare)
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Giant saltwater inflow in AD 1951 triggered Baltic Sea hypoxia
- 2024
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Ingår i: Boreas. - : John Wiley & Sons. - 0300-9483 .- 1502-3885. ; 53:2, s. 125-138
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Tidskriftsartikel (refereegranskat)abstract
- A marked sedimentological change in subsurface sediments from the entire Baltic Proper, the Baltic Sea, has been previously noted. Our detailed work on a variety of multi-cores from basin-wide transects indicates that this sedimentological change was caused by a large shift in environmental conditions during the 1950s. Until the 1950s, the water column was rather weakly stratified and winter-time convection - although weakened during the post Little Ice Age warming - was still able to ventilate the bottom waters of the Baltic Proper. Therefore, complete sediment sequences only accumulated in calm waters deeper than 150-160 m. High-resolution benthic foraminiferal records of subsurface sediments obtained along the saline water inflow pathway in combination with historical data indicate that the depositional environment changed drastically owing to the giant saline water inflow in AD 1951. The accompanied sharpening of the halo(pycno)cline triggered a collapse in the ventilation of the basin, resulting in oxygen-deficient bottom waters. This deficiency, in turn, caused the onset of phosphate release from the sediments, which accelerated primary production. The ventilation collapse also enabled the onset of deposition of organic carbon-rich sediments also in shallower water areas as calm conditions prevailed up to the modern winter mixing depth (60-70 m). A slight return to Little Ice Age-type conditions was observed during the late 1980s when temperatures decreased and stratification weakened. These conditions gave rise to a reduction in hypoxic areas and to a bottom-water ventilation, most pronounced in the north of the so-called Baltic Sea Klint, a hydrographic and topographic barrier. However, the general environmental conditions essentially have not changed since the 1950s. Remarkably, external (temperature and stratification) in combination with internal factors (e.g. ventilation collapse and phosphate release) were able to change the redox conditions of the Baltic Proper from oxic to hypoxic within less than 10 years. A marked sedimentological change seen in sub-recent seabed sediment cores from the entire Baltic proper can be attributed to large hydrographic and environmental changes that started at the end of the Little Ice Age and were accelerated by a rapid change in stratification resulting from the massive inflow of saline water in AD 1951. The increase in stratification caused a collapse of the already weakened vertical winter-time deep water convection leading to hypoxia in the bottom waters, which in turn forced a sudden phosphate release from the sediments and increased primary production in the late 1950s.image
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