| 1. |
- Eeg-Olofsson, Måns, 1967, et al.
(författare)
-
TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial
- 2022
-
Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 26:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. Methods: SARS-CoV-2-infected patients within the Region Vastra Gotaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (<= 7 days after intubation) or late tracheotomy (>= 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. Results: One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference:- 1.5 days (95% CI -5.7 to 2.8); p= 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: - 8.0 days (95% CI - 13.8 to - 2.27); p= 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman's correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. Conclusions: The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out.
|
|
| 2. |
- Lowhagen, Karin, 1973, et al.
(författare)
-
A new non-radiological method to assess potential lung recruitability: a pilot study in ALI patients.
- 2011
-
Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 55:2, s. 165-74
-
Tidskriftsartikel (refereegranskat)abstract
- Potentially recruitable lung has been assessed previously in patients with acute lung injury (ALI) by computed tomography. A large variability in lung recruitability was observed between patients. In this study, we assess whether a new non-radiological bedside technique could determine potentially recruitable lung volume (PRLV) in ALI patients.
|
|
| 3. |
- Lowhagen, Karin, 1973
(författare)
-
Monitoring alveolar recruitment in the critically ill - Patient studies using electric impedance tomography and volume-dependent compliance.
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with a high mortality rate and poor long term outcome in terms of quality of life, for those who survive. Similarly, patients with morbid obesity are at risk for respiratory complications when subjected to anaesthesia and surgery. To improve treatment and subsequently outcome for these patient groups, new treatment strategies and bedside monitoring techniques are needed. Methods: 31 patients were ... merstudied, of whom 15 were morbidly obese patients undergoing laparoscopic gastric by-pass surgery, and 16 ALI/ARDS patients mechanically ventilated in the early phase of the disease. Electric impedance tomography (EIT) was used to follow changes in end-expiratory lung volume (EELV), to titrate positive end-expiratory pressure (PEEP) and to monitor regional distribution of ventilation, as well as intratidal gas distribution of the inspiratory phase of the respiratory cycle. Tracheal pressure was measured and combined with volume measures to obtain tracheal pressure/volume (P/V) loops, from which were obtained alveolar P/V curves and volume dependent compliance (VDC). Cardiac output was measured using oesophageal Doppler technique. Results: When EIT was used to titrate PEEP in patients with morbid obesity during laparoscopic surgery, a high PEEP of 13-17 cmH2O was needed to maintain EELV. A prolonged moderate pressure recruitment manoeuvre resulted in a slightly larger EELV increase in ALI/ARDS patients compared to a vital capacity manoeuvre, both when measured at PEEP 16 cmH2O after the recruitment manoeuvre (RM). The prolonged manoeuvre also led to a lower optimal PEEP and plateau pressure when assessed during a decremental PEEP trial post RM. The vital capacity manoeuvre caused a marked decrease in cardiac output, which was not seen with the prolonged lower pressure RM. Volume-dependent compliance appeared more sensitive for detection of lung recruitment than conventional two-point compliance. Potential lung recruitability was assessed using an extrapolation method in combination with EIT for open lung volume determination. Potentially recruitable lung volume varied widely among the ALI/ARDS patients, where patients with high recruitability seemed to benefit from higher PEEP levels than those with low recruitability. The increase in EELV following a RM was mainly distributed to the non-dependent lung areas, whereas the tidal volume gas distribution was shifted towards more dependent areas. Intratidal gas was gradually redistributed dorsally during inspiration when pressure increased. Conclusion: Electric impedance tomography has many potential clinical applications, including monitoring of alveolar recruitment, assessment of lung recruitability when combined with volume-dependent compliance, and determining regional and intratidal distribution of ventilation. This will help to improve individualized ventilatory treatment, with the potential to decrease the incidence of ventilator induced lung injury (VILI).
|
|
| 4. |
- Lowhagen, Karin, 1973, et al.
(författare)
-
Prolonged moderate pressure recruitment manoeuvre results in lower optimal positive end-expiratory pressure and plateau pressure.
- 2011
-
Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 55:2, s. 175-84
-
Tidskriftsartikel (refereegranskat)abstract
- In acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), recruitment manoeuvres (RMs) are used frequently. In pigs with induced ALI, superior effects have been found using a slow moderate-pressure recruitment manoeuvre (SLRM) compared with a vital capacity recruitment manoeuvre (VICM). We hypothesized that the positive recruitment effects of SLRM could also be achieved in ALI/ARDS patients. Our primary research question was whether the same compliance could be obtained using lower RM pressure and subsequent positive end-expiratory pressure (PEEP). Secondly, optimal PEEP levels following the RMs were compared, and the use of volume-dependent compliance (VDC) to identify successful lung recruitment and optimal PEEP was evaluated.
|
|
| 5. |
|
|
| 6. |
- Rackauskaite, Dovile, et al.
(författare)
-
Prospective study: Long-term outcome at 12-15years after aneurysmal subarachnoid hemorrhage
- 2018
-
Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 138:5, s. 400-407
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatients with aneurysmal subarachnoid hemorrhage (aSAH) have poor outcome. Studies on outcome beyond 1year post-aSAH are few, and late recovery is poorly investigated, initiating this prospective outcome study on patients 12-15years after an aSAH. We hypothesized to find; functional improvement>1year post-ictus; increased long-term mortality in aSAH patients vs matched controls, and finally to present; predictors of long-term favorable outcome (GOS 4-5). MethodsWe prospectively investigated patients, admitted 2000-2003 to the Sahlgrenska University Hospital, 1year post-ictus using Glasgow Outcome Scale (GOS). The patients were revalidated 12-15years post-aSAH by structured-telephone interviews (GOS), followed by statistical analysis. ResultsA total of 158 patients were included, (women n=114, men n=44), with a mean age of 55years at aSAH. Patients treated with surgical clipping had lower mortality. At the follow-up 12-15years post-aSAH, all 103 survivors (65.2%) were categorized as having; good recovery (39.9%), moderate disability (15.2%), or severe disability (10.1%). Within the patient cohort, 23.6% improved GOS over time. Fifty-five patients died, median at 4years post-ictus. aSAH patients had 3.5 times increased mortality 12-15years post-ictus vs matched controls (P<.0001). Patients with favorable outcome at 1year (67.3%, n=101) had similar survival probability as control patients. Prognostic indicators of long-term favorable outcome were low age and high GOS at 1-year follow-up, (AUCROC, 0.79). ConclusionsIndividual functional improvement was found >1year post-ictus. Patients with favorable outcome at 1year had similar long-term life expectancy as the general population. Indicators of long-term favorable prognosis were low age at ictus and high GOS at 1-year follow-up.
|
|
