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- Disma, Nicola, et al.
(författare)
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Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) : a prospective European multicentre observational study.
- 2021
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 126:6, s. 1173-1181
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality.CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.CLINICAL TRIAL REGISTRATION: NCT02350348.
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| 2. |
- Engert, Andreas, et al.
(författare)
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The European Hematology Association Roadmap for European Hematology Research : a consensus document
- 2016
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Ingår i: Haematologica. - Pavia, Italy : Ferrata Storti Foundation (Haematologica). - 0390-6078 .- 1592-8721. ; 101:2, s. 115-208
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Tidskriftsartikel (refereegranskat)abstract
- The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at (sic)23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients.
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| 3. |
- Disma, Nicola, et al.
(författare)
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Morbidity and mortality after anaesthesia in early life : results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE).
- 2021
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 126:6, s. 1157-1172
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown.METHODS: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events.RESULTS: Infants (n=5609) born at mean (standard deviation [sd]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]=1.16; 95% confidence interval [CI], 1.04-1.28) and in those requiring preoperative intensive support (RR=1.27; 95% CI, 1.15-1.41). Additional complications occurred in 16.3% of patients by 30 days, and overall 90-day mortality was 3.2% (95% CI, 2.7-3.7%). Co-occurrence of intraoperative hypotension, hypoxaemia, and anaemia was associated with increased risk of morbidity (RR=3.56; 95% CI, 1.64-7.71) and mortality (RR=19.80; 95% CI, 5.87-66.7).CONCLUSIONS: Variability in physiological thresholds that triggered an intervention, and the impact of poor tissue oxygenation on patient's outcome, highlight the need for more standardised perioperative management guidelines for neonates and infants.CLINICAL TRIAL REGISTRATION: NCT02350348.
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| 4. |
- Frykholm, Peter, 1961-, et al.
(författare)
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Preoperative fasting in children. The evolution of recommendations and guidelines, and the underlying evidence
- 2024
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Ingår i: Best Practice & Research. - : Elsevier. - 1521-6896 .- 1532-169X. ; 38:2, s. 103-110
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Tidskriftsartikel (refereegranskat)abstract
- This review discusses the evolution of preoperative fasting guidelines and examines the incidence of pulmonary aspiration of gastric contents and suggested treatments. Nine guidelines developed by professional societies and published in peer-reviewed journals since 1994 were identified. The recommendations on preoperative fasting for various categories have undergone only small adaptations in the following three decades in pediatric anesthesia. We found twelve published studies of the incidence of pulmonary aspiration, which ranges from 0.6 to 12 in 10,000 anesthetics in children. However, this variation reflects differences in the definition of aspiration as well as differences in study design. The main risk factors identified are emergency surgery, ASA physical status, and patient age. Several additional risk factors have been suggested, including non-compliance to fasting guidelines. The duration of clear fluid fasting is not associated with an increased risk of pulmonary aspiration which may be reflected in future guideline updates in pediatric anesthesia.
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| 8. |
- Peng, Xinxia, et al.
(författare)
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The draft genome sequence of the ferret (Mustela putorius furo) facilitates study of human respiratory disease
- 2014
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Ingår i: Nature Biotechnology. - : Springer Science and Business Media LLC. - 1087-0156 .- 1546-1696. ; 32:12, s. 1250-U114
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Tidskriftsartikel (refereegranskat)abstract
- The domestic ferret (Mustela putorius furo) is an important animal model for multiple human respiratory diseases. It is considered the 'gold standard' for modeling human influenza virus infection and transmission(1-)4. Here we describe the 2.41 Gb draft genome assembly of the domestic ferret, constituting 2.28 Gb of sequence plus gaps. We annotated 19,910 protein-coding genes on this assembly using RNA-seq data from 21 ferret tissues. We characterized the ferret host response to two influenza virus infections by RNA-seq analysis of 42 ferret samples from influenza time-course data and showed distinct signatures in ferret trachea and lung tissues specific to 1918 or 2009 human pandemic influenza virus infections. Using microarray data from 16 ferret samples reflecting cystic fibrosis disease progression, we showed that transcriptional changes in the CFTR-knockout ferret lung reflect pathways of early disease that cannot be readily studied in human infants with cystic fibrosis disease.
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| 9. |
- Tannheimer, Markus, et al.
(författare)
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Auto-PEEP in the therapy of AMS in one person at 4,330 m.
- 2009
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Ingår i: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 13:2, s. 195-199
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Tidskriftsartikel (refereegranskat)abstract
- Background The human organism is exposed to considerable hypoxic stress at high altitudes. Our intention was to investigate if a special breathing pattern with expiration against the resistance of pursed lips leads to an elevation in oxygen saturation (SaO2). For the first time ever, oxygen saturation was measured continuosly during the initial situation, during self-performed positive end-expiratory pressure breathing (auto-PEEP) itself, and during observation afterwards. Materials and methods The investigation was performed on a 33-year-old male suffering from high-altitude illness (Lake Louise Score, 9) after a 4-day rapid ascent from 350 m to 4,330 m during an expedition to Mount McKinley (6,198 m). SaO2 was measured continuously at 4-s intervals. After a rest of 1.5 h in a dorsal recumbent position with a slightly elevated (about 15°) upper body, the patient used a wristwatch to breathe according to a special time pattern (inspiration 2 s, expiration 8 s against the resistance of pursed lips). After 30 min, breathing was then allowed without any restrictions, and the inspiration/expiration ratio was approximately 1:1. Results There was a relatively sharp rise in SaO2 from an average of 62% to 85% within only 5 min after auto-PEEP began. This was followed by a comparable rise to values of 95% at the end of the auto-PEEP period. During normal breathing, SaO2 decreased slowly within half an hour to values of about 70% and remained at this level. The person reported relief in symptoms and no exhaustion. Vertigo—an indication of hypocapnia caused by hyperventilation—was not observed. Discussion The 30% rise in SaO2 and the improved saturation level after auto-PEEP are remarkable. Elevated intra-thoracal pressure may lead to a reopening of collapsed alveoli in addition to an improved gradient of alveolarcapillary pressure. In addition, a pressure-induced displacement of interstitial fluid resulting in a reduced diffusion distance may lead to improved alveolar-capillary diffusion. This would explain the slower rise in SaO2 after 10 min of auto-PEEP and the elevated level of SaO2 compared to the initial level before auto-PEEP. Conclusion As a result of the substantial and lasting improvement in SaO2 in combination with relief in AMS symptoms and its easy use, auto-PEEP (30 min every 2 h) can be a useful therapy option in the event of high-altitude-induced hypoxia and AMS.
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