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- Eiriksson, Kristinn, 1967-, et al.
(författare)
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Is there a difference between carbon dioxide and argon gas embolisms in laparoscopic liver resection?
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background:Several methods are available to control bleeding during laparoscopic liver resection (LLR). One of these techniques, argon enhanced coagulation (AEC), could be hazardous because of the argon gas. Argon gas has poorer solubility in blood than CO2. Previous animal studies have shown the danger of gas embolism during LLR. The aim of this study was to compare the effects of Argon gas embolism and CO2 embolism, with special emphasis on pulmonary circulation and gas exchange, during laparoscopic liver surgery.Method:Sixteen piglets underwent laparoscopic left lateral liver resection and were randomised to either CO2 or argon pneumoperitoneum, at 16 mmHg. The pulmonary circulation of the animals was monitored with a pulmonary arterial catheter. Paratrend® was used to continuously measure PaCO2, PaO2, and pH, and transoesophageal ultrasound was used to detect embolisms on the right side of the heart.Results: Equal amount of embolism were seen in both groups. The mean pulmonary arterial pressure (MPAP) increased in the Argon-group (P=0.050) as did the pulmonary vascular resistance (PVR) (P=0.015) compared with the CO2-group, correlating with the amount of embolism. The gas exchange was then affected with an decrease in PaO2 and increase in PaCO2 , resulting in acidosis.Conclusion:Argon gas embolism has more effects on pulmonary circulation and gas exchange than CO2. If used, great care should be taken with argon gas and the patient should be carefully monitored during LLR.
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| 2. |
- Lindgren, Erik, et al.
(författare)
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Gender differences in short- and long-term outcome after out-of-hospital cardiac arrest. Analysis of the LINC trial.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: We aimed to identify gender differences in survival after out-of-hospital cardiac arrest (OHCA).Methods: 2,589 OHCA victims were analyzed, 33.3% women, from the LINC trial. After identifying gender differences in baseline characteristics, cardiac arrest (CA) events and survival rates, multivariable logistic regression was performed irrespective of treatment group.Results: Unadjusted analysis demonstrated no difference between women and men in 4- hour survival, 22.1% vs. 24.4% (p=0.20). Women had lower survival rates at hospital discharge, 6.7% vs. 10.1% (p=0.003) and after 6 months, 5.9% vs. 9.5% (p=0.002). Women were older, 71.5 vs. 67.9 years of age (p<0.001), had lower rates of CA with suspected cardiac aetiology, 63.8% vs. 74.3% (p<0.001), and shockable first rhythm, 18.9% vs. 35.0% (p<0.001). More women had crew-witnessed CA, 9.3% vs. 6.0% (p=0.002). There was no difference regarding witnessed CA, 65.3% vs. 67.2% (p=0.33) and bystander CPR, 55.2% vs. 57.7% (p=0.24).After adjusting for age, randomization group, witnessed CA, bystander CPR, first analysed rhythm and cardiac aetiology, female gender was an independent predictor for 4-hour survival, OR 1.34 (95% C.I. 1.06 – 1.69) but not for survival at hospital discharge, OR 1.19 (95% C.I. 0.83 – 1.72) or after 6 months, OR 1.12 (95% C.I. 0.76 – 1.63).Fewer women were treated with coronary angiography, percutaneous coronary intervention and therapeutic hypothermia, 23.5% vs. 45.7% (p<0.001), 14.5% vs. 30.2% (p<0.001), 54.0% vs. 69.1% (p<0.001), respectively.Conclusions: Female gender was an independent predictor for early survival. At hospital discharge and after 6 months these gender differences in survival were no longer found.
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| 4. |
- Wallin, Ewa, et al.
(författare)
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The prognostic value of using a jugular bulb catheter for measuring oxygen saturation in patients treated with target temperature management 33˚C after cardiac arrest: a prospective study.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To describe variations in jugular bulb oxygen saturation (SjvO2), differences in oxygen content between central venous oxygen saturation (ScvO2) and SjvO2, and oxygen extraction fraction from the brain (OEFb) during intensive care in relation to neurological outcome at 6 months post-cardiac arrest (CA) in cases where target temperature management to 33°C (TTM) was applied.Design: Prospective observational study.Setting: One general intensive care unit in a university hospital.Patients: Patients over 18 years, comatose immediately after resuscitation from CA, regardless of first registered ECG rhythm or whether the CA occurred in or out of hospital.Interventions: None.Measurements and Main Results: One hundred and ten patients were treated with TTM 33°C post-CA and 76 received a single lumen catheter in the right jugular vein. Oxygen saturation from the arterial, jugular bulb and central venous catheter was measured in 75 patients during TTM 33°C and up to 108 hours post-CA. Neurological outcome was assessed using the Cerebral Performance Categories (CPC) and dichotomized into good and poor outcome. Thirty-seven (49%) patients survived with a good outcome (CPC 1-2) at 6 months. Patients with poor outcome showed higher levels of SjvO2 at 6,12, 96 and 108 hours, but this was only significant at 12 (p=0.032), 96 (p=0.018) and 108 hours (p=0.015).Patients with a good outcome showed higher in ScvO2 -SjvO2 values at 6 hours (p=0.001) post-CA. The OEFb was higher in patients with good outcome at 6 (p=0.048), 12 (p=0.015), 96 (p=0.008) and 108 hours (p=0.017).Conclusions: In the present study, the main differences in the oxygen saturation measures were seen at 6, 12, 96 and 108 hours post-CA. Based on the present findings, we cannot recommend that the values obtained from the jugular bulb catheter post-CA be used to predict outcome, and thus the usefulness of SjvO2 for prognostic purposes is uncertain
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| 6. |
- Wulf Hanson, Sarah, et al.
(författare)
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A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021
- 2022
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Importance: While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID.Objective: To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery.Design: We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study.Results: Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9-92.4), 60.4% (18.9-89.1), and 35.4% (9.4-75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84-4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10-9.78]). At twelve months, 15.1% (10.3-21.1) continued to experience long COVID symptoms.Conclusions and relevance: The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane.Key Points: Question: What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021?Findings: Globally, 144.7 million people experienced one or more of three symptom clusters (fatigue; cognitive problems; and ongoing respiratory problems) of long COVID three months after infection, in 2020 and 2021. Most cases arose from milder infections. At 12 months after infection, 15.1% of these cases had not yet recovered.Meaning: The substantial number of people with long COVID are in need of rehabilitative care and support to transition back into the workplace or education when symptoms start to wane.
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