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- Eeg-Olofsson, Måns, 1967, et al.
(författare)
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TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial
- 2022
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 26:1
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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.
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| 2. |
- Olofsson, Helén, 1965-
(författare)
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Skriftbruk i fordonsverkstaden : En studie av läs- och skrivstrategier i mötet med arbetslivets texter
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the study was to describe the reading and writing activities that takes place in vehicle repair workshops and to elucidate how people experiencing low reading-and-writing ability describe their encounters with text in working life. Reading and writing are considered in the study from an educational-philosophical and special educational perspective. This study of literacy was inspired by ethnographic methods. The empirical material consists of field notes from ten participatory observations in vehicle repair workshops, photographs from the workshops and three interviews. To see patterns in how literacy was used, literacy events were taken as the unit of analysis. The literacy environment, community of practice, reading path and technical surroundings are analytical concepts in the thematic presentation of results. Central literacy practices were characterized primarily by reading, often via computer, for information needed for solving problems. The type of reading was often non-linear, given the multimodal texts and choices in computer environments. In addition, semiotic systems and several languages were interpreted. It is important to understand how information is organised and how to handle the technology. Technology provides support structures e.g. pictorial support and translation programmes. Writing out words, button-pushing and keyboard entry to register and search for information through the use of measurement instruments and in computer-generated text environments, were central. Literacy events were embedded in the work tasks and in ongoing learning, and many literacy practices included items of both reading and writing. Social skills, plus recognizing one’s problems and asking for help, were useful strategies for handling the demands of reading and writing in working life, as were allowing time and creating concentration for the task. Interpreting pictorial matter, using technology, copying text and noting down things to remember were further strategies. Implications of the study are that effective strategies for managing the demands of reading and writing that are required in the working place should begin in school. Significant is the teachers’ approach to handling the students’ frustration when studies are not working out as expected. Caring teachers, positive energy and not giving up make a difference. General education teachers need special educational resources in the upper-secondary school in order to counteract school failure and to enhance students’ learning.
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