| 1. |
- Gunnarsdottir, Gudrun M., et al.
(författare)
-
Validation of the Hospital Frailty Risk Score in older surgical patients : A population-based retrospective cohort study
- 2021
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 65:8, s. 1033-1042
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is a need for standardized and cost-effective identification of frailty risk. The objective was to validate the Hospital Frailty Risk Score which utilizes International Classification Diagnoses in a cohort of older surgical patients, assess the score as an independent risk factor for adverse outcomes and compare discrimination properties of the frailty risk score with other risk stratification scores.Methods: Data were analysed from all patients >= 65 years undergoing primary surgical procedures from 2006-2018. Patients were categorized based on the frailty risk score. The primary outcomes were 30-day mortality and 180-day risk of readmission.Results: Of 16 793 patients evaluated, 7480 (45%), 7605 (45%) and 1708 (10%) had a low, intermediate and high risk of frailty. There was a higher incidence of 30-day mortality for individuals with intermediate (2.9%) and high (8.3%) compared with low (1.4%) risk of frailty (P < .001 for both comparisons). Similarly, the hazard of readmission within the first 180 days was higher for intermediate (HR 1.25; 95% CI: 1.16-1.34) and high (HR 1.84; 95% CI: 1.66-2.03) compared with low (HR 1.00, P < .001 for both comparisons) risk of frailty. The hazard of long-term mortality was higher for intermediate (HR 1.70; 95% CI: 1.61-1.80) and high (HR 4.16; 95% CI: 3.84-4.49) compared with low (HR 1.00, P < .001 for both comparisons) risk of frailty. Finally, long length of primary hospitalization occurred for 9.3%, 15.0% and 27.3% of individuals with low, intermediate and high frailty risk (P < .001 for all comparisons). A model including age and ASA classification had the best discrimination for 30-day mortality (AUC 0.862; 95% CI: 0.847-0.877).Conclusion: Our findings suggest that the Hospital Frailty Risk Score might be used to screen older surgical patients for risk of frailty. While only slightly improving prediction of 30-day mortality using the ASA classification, the Hospital Frailty Risk Score can be used to independently classify older patients for the risk of important outcomes using pre-existing readily available electronic data.
|
|
| 2. |
- Kárason, Sigurbergur, 1964
(författare)
-
Spirodynamics. New methods for continuous monitoring of respiratory mechanics in ventilator-treated patients
- 2000
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Ventilator treatment is often life-saving but has the inherent risk of causing damage to lung tissues. Overdistension and repetitive collapsing/opening of alveoli should be avoided. Monitoring of respiratory mechanics has a central role in accomplishing this. Methods used today to identify pressure/volume (P/V) curves are based on static/semistatic methods that necessitate a change of ventilator settings and have mainly been used as research tools. The aim of this thesis was to develop clinically applicable methods for continuous and thorough monitoring of respiratory mechanics during on-going ventilator treatment.Methods: Studies were performed in a lung model and in patients. The use of catheters for measurement of oesophageal and tracheal pressures was evaluated. The dynostatic algorithm was created and validated for calculation of alveolar P/V-curves during dynamic conditions. The algorithm analyses pressure and flow at isovolume levels on the inspiratory and expiratory limbs of a tracheal P/V-loop, for every sample during the breath, assuming that the inspiratory and expiratory resistances are equal. Respiratory mechanics in 10 patients with acute lung injury were studied at different PEEP and tidal volume levels using this method.Results: A double-lumen, liquid-filled stomach tube measures oesophageal pressure reliably when positioned accurately. Direct measurements of tracheal pressures are a necessity for monitoring of respiratory mechanics and can be achieved by inserting an end-hole catheter through the endotracheal tube lumen, positioning its tip within 2 cm from the tip of the tube. The dynostatic method is highly reliable when the ratio between inspiratory and expiratory resistances is between 2.3:1 and 1:2.3. Respiratory mechanics during on-going ventilator treatment showed a high individual variability but good reproducibility. Within each breath, volume-dependent compliance decreased successively through the initial, middle and final parts of the P/V-curve. This pattern became more prominent with increased PEEP and tidal volume levels, indicating increased overdistension.Conclusions: The monitoring concept presented provides a safe, accurate and continuous method of monitoring of respiratory mechanics during on-going ventilator treatment.
|
|
| 3. |
- Odenstedt, Helena, 1968, et al.
(författare)
-
Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI.
- 2005
-
Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 31:1, s. 112-20
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess acute cardiorespiratory effects of recruitment manoeuvres in experimental acute lung injury. DESIGN: Experimental study in animal models of acute lung injury. SETTING: Experimental laboratory at a University Medical Centre. ANIMALS: Ten pigs with bronchoalveolar lavage and eight pigs with endotoxin-induced ALI. INTERVENTIONS: Two kinds of recruitment manoeuvres during 1 min; a) vital capacity manoeuvres (ViCM) consisting in a sustained inflation at 30 cmH(2)O and 40 cmH(2)O; b) manoeuvres obtained during ongoing pressure-controlled ventilation (PCRM) with peak airway pressure 30 cmH(2)O, positive end-expiratory pressure (PEEP) 15 and peak airway pressure 40, PEEP 20. Recruitment manoeuvres were repeated after volume expansion (dextran 8 ml/kg). Oxygenation, mean arterial, and pulmonary artery pressures, aortic, mesenteric, and renal blood flow were monitored. MEASUREMENTS AND RESULTS: Lower pressure recruitment manoeuvres (ViCM30 and PCRM30/15) did not significantly improve oxygenation. With ViCM and PCRM at peak airway pressure 40 cmH(2)O, PaO(2) increased to similar levels in both lavage and endotoxin groups. Aortic blood flow was reduced from baseline during PCRM40/20 and ViCM40 by 57+/-3% and 61+/-6% in the lavage group and by 57+/-8% and 82+/-7% (P<0.05 vs PCRM40/20) in endotoxin group. The decrease in blood pressure was less pronounced. Prior volume expansion attenuated circulatory impairment. After cessation of recruitment hemodynamic parameters were restored within 3 min. CONCLUSION: Effective recruitment resulted in systemic hypotension, pulmonary hypertension, and decrease in aortic blood flow especially in endotoxinemic animals. Circulatory depression may be attenuated using recruitment manoeuvres during ongoing pressure-controlled ventilation and by prior volume expansion.
|
|
| 4. |
|
|
