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| 2. |
- Johnsson, Per, et al.
(författare)
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Increased S100B in blood after cardiac surgery is a powerful predictor of late mortality
- 2003
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 75:1, s. 162-168
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLong-term outcome in patients who suffered stroke after undergoing a cardiac operation has been investigated sparingly, but increased long-term mortality has been reported. S100B is a biochemical marker of brain cell ischemia and blood–brain barrier dysfunction. The aim of this investigation was to record the long-term mortality in consecutive patients undergoing cardiac operations and to explore whether increased concentrations of S100B in blood had a predictive value for mortality.MethodsProspectively collected clinical variables, including S100B, in 767 patients who survived more than 30 days after a cardiac operation, were analyzed with actuarial survival analysis and 678 patients were analyzed with Cox multiple regression analysis.ResultsForty-nine patients (6.4%) were dead at follow-up (range, 18 to 42 months); 11.5% (88 of 767 patients) had elevated S100B 2 days after operation (range, 38 to 42 hours). The probability for death at follow-up was 0.239 if the S100B level was more than 0.3 μg/L, and 0.041 if it was less than 0.3 μg/L. The clinical variables independently associated with mortality were preoperative renal failure, preoperative low left ventricular ejection fraction, emergency operation, severe postoperative central nervous system complication, and elevated S100B values, which turned out to be the most powerful predictor.ConclusionsEven slightly elevated S100B values in blood 2 days after cardiac operation imply a bad prognosis for outcome, and especially so in combination with any central nervous system complication.
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| 3. |
- Samuelsson Palmgren, Gabriella, et al.
(författare)
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Platelet retention in coronary artery bypass surgery with and without a heart-lung machine. Cause of thrombosis in coronary artery bypass surgery
- 2000
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 34:3, s. 301-306
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine platelet function after coronary artery bypass grafting (CABG) with and without the use of extracorporeal circulation (ECC). Sixteen male patients scheduled for CABG with (n = 8) and without (n = 8) ECC were included in the study. Platelet retention, as measured with a glass-bead retention test, was examined daily during the first postoperative week. Von Willebrand factor (vWF), ristocetin co-factor (Rcof) and prothrombin fragment (PF 1 + 2) were analyzed the day after the operation. We found a significant increase (p < 0.0001) in platelet retention during the first postoperative week after CABG. There was a tendency (not statistically significant) towards a more pronounced increase in the group operated on without ECC. This increase occurred despite the fact that all patients were treated with aspirin (75 mg daily) from the first postoperative day. The median time to maximal postoperative platelet retention was 2 days. In 3 patients platelet retention increased to more than 6 times the basal level.
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| 4. |
- Jönsson, Henrik, et al.
(författare)
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Controversial significance of early S100B levels after cardiac surgery
- 2004
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe brain-derived protein S100B has been shown to be a useful marker of brain injury of different etiologies. Cognitive dysfunction after cardiac surgery using cardiopulmonary bypass has been reported to occur in up to 70% of patients. In this study we tried to evaluate S100B as a marker for cognitive dysfunction after coronary bypass surgery with cardiopulmonary bypass in a model where the inflow of S100B from shed mediastinal blood was corrected for.Methods56 patients scheduled for coronary artery bypass grafting underwent prospective neuropsychological testing. The test scores were standardized and an impairment index was constructed. S100B was sampled at the end of surgery, hourly for the first 6 hours, and then 8, 10, 15, 24 and 48 hours after surgery. None of the patients received autotransfusion.ResultsIn simple linear analysis, no significant relation was found between S100B levels and neuropsychological outcome. In a backwards stepwise regression analysis the three variables, S100B levels at the end of cardiopulmonary bypass, S100B levels 1 hour later and the age of the patients were found to explain part of the neuropsychological deterioration (r = 0.49, p < 0.005).ConclusionsIn this study we found that S100B levels 1 hour after surgery seem to be the most informative. Our attempt to control the increased levels of S100B caused by contamination from the surgical field did not yield different results. We conclude that the clinical value of S100B as a predictive measurement of postoperative cognitive dysfunction after cardiac surgery is limited.
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| 5. |
- Steen, Stig, et al.
(författare)
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Transplantation of lungs from a non-heart-beating donor
- 2001
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Ingår i: The Lancet. - 1474-547X. ; 357:9259, s. 825-829
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In animals, we have previously done successful lung transplantations using organs from non-heart-beating donors. We have also developed an ex-vivo system of assessing the function of such organs before transplantation. The next stage was to try the technique in human beings. Bearing in mind the sensitive ethical issues involved, our first aim was to find out what procedures would be acceptable, and to use the results to guide a clinical lung transplantation from a non-heart-beating donor. METHODS: The ethical acceptability of the study was gauged from the results of a broad information programme directed at the general public in Sweden, and from discussions with professionals including doctors, nurses, hospital chaplains, and judges. The donor was a patient dying of acute myocardial infarction in a cardiac intensive-care unit after failed cardiopulmonary resuscitation. The next of kin gave permission to cool the lungs within the intact body, and intrapleural cooling was started 65 min after death. Blood samples were sent for virological testing and cross matching. The next of kin then had time to be alone with the deceased. After 3 h, the body was transported to the operating theatre and the heart-lung block removed. The lungs were assessed ex vivo, and the body was transported to the pathology department for necropsy. RESULTS: No contraindications to transplantation were found, and the right lung was transplanted successfully into a 54-year-old woman with chronic obstructive pulmonary disease. The donor lung showed excellent function only 5 min after reperfusion and ventilation, and during the first 5 months of follow-up, the function of the transplanted lung has been good. INTERPRETATION: About half the deaths in Sweden are caused by cardiac and cerebrovascular disease. This group could be a potential source of lung donors. When all hospitals and ambulance personnel in Sweden have received training in non-heart-beating lung donation, we hope that there will be enough donor lungs of good quality for all patients needing a lung transplant.
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| 6. |
- Sundgren, Pia, et al.
(författare)
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Value of conventional, and diffusion- and perfusion weighted MRI in the management of patients with unclear cerebral pathology, admitted to the intensive care unit
- 2002
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Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 44:8, s. 674-680
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Tidskriftsartikel (refereegranskat)abstract
- The aim of our retrospective study was to determine the extent to which diffusion- and perfusion- weighted MRI combined with conventional MRI could be helpful in the evaluation of intensive care unit (ICU) patients who have unknown or unclear cerebral pathology underlying a serious clinical condition. Twenty-one ICU patients with disparity between the findings on brain CT scan and their clinical status were studied. All patients underwent conventional MR and diffusion-weighted imaging and 14 also had MR perfusion studies. Abnormalities were present on diffusion-weighted imaging of 17 of the 21 patients and on perfusion-weighted studies of 7 of 14 patients. The MRI results changed the preliminary/working diagnosis in six patients. In eight other patients, MRI revealed additional pathology that had not been suspected clinically, and/or characterized more closely findings that had already been detected by CT or suspected clinically. MRI showed abnormalities in four of the five patients who had normal CT. MRI findings suggested a negative clinical outcome in all nine patients who subsequently died. MRI findings also suggested positive long-term outcome in five of nine patients who improved significantly as based on Glasgow and extended Glasgow outcome scales. In the three unconscious patients who had normal diffusion- and perfusion weighted imaging the clinical outcome was good. This study suggests that MRI in seriously ill ICU patients with unclear cerebral pathology can provide information that changes, characterizes, or supports diagnoses and/or prognoses and therefore facilitates further management.
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| 7. |
- Göthberg, Sylvia, 1953
(författare)
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New modes of improving ventilation and oxygenation in pulmonary hypertension and acute respiratory failure in newborns and children
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pulmonary hypertension leading to hypoxemia is a potentially life-threatening condition in pediatric intensive care. Hypoxemia may also result from conditions not primarily related to pulmonary hypertension. The pediatric patients with these symptoms are:· Children after surgery on cardiopulmonary bypass with pulmonary hypertension attributable to congenital heart defects with high pulmonary blood flow.· Newborns with persistent pulmonary hypertension as a symptom of fetal illness or malformation or after a relapse into fetal circulation without obvious reason.· Children with acute respiratory failure and disturbed vascular/alveolar relation with atelectases and ventilation/perfusion mismatch with major pulmonary shunt.New methods to provide better ventilation and oxygenation have been developed over the last few years. The aims of the present thesis were to assess:· The effect of inhaled nitric oxide (iNO), a selective pulmonary vasodilator, on pulmonary hypertension and oxygenation in dose-response studies.· The effect of high frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV) on alveolar recruitment and response to iNO.· Respiratory inductive plethysmography during dynamic ventilatory changes on high frequency oscillatory ventilation and on conventional ventilation (CV) as a new continuous and non-invasive method to optimize alveolar recruitment without interrupting ventilation.· Possible residual cardiopulmonary and neurological symptoms in a follow-up study after treatment with inhaled nitric oxide.The methods used were dose-response studies with iNO, lung volume recruitment with surfactant, high frequency oscillatory ventilation and partial liquid ventilation, lung volume measurements with respiratory inductive plethysmography and a four-center follow up study after iNO.Results and conclusions:· iNO decreased pulmonary artery pressure after cardiopulmonary bypass. No dose response relationship was found in the dose range of 3-80 ppm nitric oxide. Only a low dose of inhaled nitric oxide was needed, 5 ppm or less, which also concomitantly improved oxygenation in postoperative pulmonary hypertension in children.· iNO in doses up to 20 ppm immediately improved oxygenation in 68% of children with acute respiratory failure. Only 29% of non-responders survived and no delayed response was found in patients with acute respiratory failure. Non-responders need careful attention in order to improve ventilation and/or hemodynamics. Otherwise they should be transferred without delay to extracorporeal membrane oxygenation when eligible for such treatment.· Follow up after iNO treatment showed residual pulmonary hypertension in cardiac but not in lung patients. Residual respiratory disease and neurodevelopmental delay were not increased as compared with previous studies or owing to improved survival of severely ill patients.· In severe respiratory distress syndrome in preterm lambs, rescue treatment with alveolar recruitment strategies, HFOV and PLV, resulted in improved oxygenation. Alveolar recruitment was improved, as indicated by further improvement in oxygenation in response to iNO, particularly when HFOV and PLV were combined. Mean airway pressures on HFOV and CV when combined with PLV were significantly lower, reducing the risk of alveolar barotrauma.· Respiratory inductive plethysmography could be used to assess changes in lung volume during HFOV and CV in term and preterm lambs. This method provided the means to monitor and optimize lung volume continuously, non-invasively and without interruption of ventilation during mechanical ventilation. Observed changes in lung volume predicted changes in oxygenation.
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| 10. |
- Ederoth, Per, et al.
(författare)
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Blood-brain barrier transport of morphine in patients with severe brain trauma
- 2004
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Ingår i: British Journal of Clinical Pharmacology. - : Wiley. - 0306-5251 .- 1365-2125. ; 57:4, s. 427-435
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: In experimental studies, morphine pharmacokinetics is different in the brain compared with other tissues due to the properties of the blood-brain barrier, including action of efflux pumps. It was hypothesized in this clinical study that active efflux of morphine occurs also in human brain, and that brain injury would alter cerebral morphine pharmacokinetics. METHODS: Patients with traumatic brain injury, equipped with one to three microdialysis catheters in the brain and one in abdominal subcutaneous fat for metabolic monitoring, were studied. The cerebral catheter locations were classified as 'better' and 'worse' brain tissue, referring to the degree of injury. Morphine (10 mg) was infused intravenously over a 10-min period in seven patients in the intensive care setting. Tissue and plasma morphine concentrations were obtained during the subsequent 3-h period with microdialysis and regular blood sampling. RESULTS: The area under the concentration-time curve (AUC) ratio of unbound morphine in brain tissue to plasma was 0.64 (95% confidence interval 0.40, 0.87) in 'better' brain tissue (P < 0.05 vs. the subcutaneous fat/plasma ratio), 0.78 (0.49, 1.07) in 'worse' brain tissue and 1.00 (0.86, 1.13) in subcutaneous fat. The terminal half-life and T(max) were longer in the brain vs. plasma and fat, respectively. The relative recovery for morphine was higher in 'better' than in 'worse' brain tissue. The T(max) value tended to be shorter in 'worse' brain tissue. CONCLUSIONS: The unbound AUC ratio below unity in the 'better' human brain tissue demonstrates an active efflux of morphine across the blood-brain barrier. The 'worse' brain tissue shows a decrease in relative recovery for morphine and in some cases also an increase in permeability for morphine over the blood-brain barrier.
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