| 1. |
- Bartfay, Sven-Erik, et al.
(författare)
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Are biventricular assist devices underused as a bridge to heart transplantation in patients with a high risk of postimplant right ventricular failure?
- 2017
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 0022-5223 .- 1097-685X. ; 153:2
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Tidskriftsartikel (refereegranskat)abstract
- Right ventricular failure in patients treated using left ventricular assist devices is associated with poor outcomes. We assessed the strategy of preplanned biventricular assist device implantation in patients with a high risk for right ventricular failure.Between 2010 and 2014, we assigned 20 patients to preplanned biventricular assist device and 21 patients to left ventricular assist device as a bridge to heart transplantation on the basis of the estimated risk of postimplant right ventricular failure. Preimplant characteristics and postimplant outcomes were compared between the 2 groups.Patients with a biventricular assist device were younger, more often female, and more frequently had nonischemic heart disease than left ventricular assist device recipients. At preoperative assessment, biventricular assist device recipients had poorer Interagency Registry for Mechanically Assisted Circulatory Support profiles, a lower cardiac index, and more compromised right ventricular function. Survival on device to heart transplantation/weaning/destination for biventricular assist device and left ventricular assist device recipients was 90% versus 86% (not significant), with shorter heart transplantation waiting times for biventricular assist device recipients (median days, 154 vs 302, P<.001). Overall survival at 1year was 85% (95% confidence interval, 62-95) versus 86% (95% confidence interval, 64-95) (not significant). The majority of both biventricular assist device and left ventricular assist device recipients could be discharged to home during the heart transplantation waiting time (55% vs 71%, not significant), and complication rates on device were comparable between groups (major stroke 10% vs 10%, not significant).Planned in advance, the biventricular assist device seems to be a feasible option as bridge to heart transplantation for patients with a high risk of postimplant right ventricular failure. The outcomes for these patients were similarto those observed for contemporary left ventricular assist device recipients, despite those receiving biventricular assist devices being more severely ill.
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| 2. |
- Bartfay, Sven-Erik, et al.
(författare)
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Durable circulatory support with a paracorporeal device as an option for pediatric and adult heart failure patients.
- 2021
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Ingår i: The Journal of thoracic and cardiovascular surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 161:4
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Tidskriftsartikel (refereegranskat)abstract
- Not all patients in need of durable mechanical circulatory support are suitable for a continuous-flow left ventricular assist device. We describe patient populations who were treated with the paracorporeal EXCOR, including children with small body sizes, adolescents with complex congenital heart diseases, and adults with biventricular failure.Information on clinical data, echocardiography, invasive hemodynamic measurements, and surgical procedures were collected retrospectively. Differences between various groups were compared.Between 2008 and 2018, a total of 50 patients (21 children and 29 adults) received an EXCOR as bridge to heart transplantation or myocardial recovery. The majority of patients had heart failure compatible with Interagency Registry for Mechanically Assisted Circulatory Support profile 1. At year 5, the overall survival probability for children was 90%, and for adults 75% (P=.3). After we pooled data from children and adults, the survival probability between patients supported by a biventricular assist device was similar to those treated with a left ventricular assist device/ right ventricular assist device (94% vs 75%, respectively, P=.2). Patients with dilated cardiomyopathy had a trend toward better survival than those with other heart failure etiologies (92% vs 70%, P=.05) and a greater survival free from stroke (92% vs 64%, P=.01). Pump house exchange was performed in nine patients due to chamber thrombosis (n=7) and partial membrane rupture (n=2). There were 14 cases of stroke in eleven patients.Despite severe illness, patient survival on EXCOR was high, and the long-term overall survival probability following heart transplantation and recovery was advantageous. Treatment safety was satisfactory, although still hampered by thromboembolism, mechanical problems, and infections.
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| 3. |
- Bengtsson, Daniel, et al.
(författare)
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Sterility and oxygenator function in pre-primed extracorporeal membrane oxygenation: A prospective clinical study
- 2024
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Ingår i: RESUSCITATION PLUS. - 2666-5204. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Minimizing cardiac arrest times is critical in extracorporeal cardiopulmonary resuscitation (ECPR). Pre-primed extra corporeal membrane oxygenator (ECMO) is used for this, but knowledge is limited to experimental studies. We prospectively investigated oxygenator function and sterility in dry plus wet pre-priming in a clinical setting. Methods: This prospective clinical study included 107 ECMO circuits used at Sahlgrenska University Hospital between October 2019 and December 2021. Circuits underwent dry set-up, followed by wet priming when the previous wet-primed circuit was used. Sterility was assessed by culturing the priming solution. Oxygenator function parameters, including sweep gas flow, fraction of oxygen (FiO(2)), and oxygenator resistance, were analyzed at ECMO initiation and during treatment using linear mixed models. Results: Median total set-up time was 14 days (range 0-97), with a median wet prime time of 6 days (range 0-57). 103 of 105 circuits with culture results were negative, two showed bacterial growth (coagulase-negative staphylococci and Cutibacterium acnes). Wet prime time did not significantly affect initial oxygenator function. Oxygenator resistance and FiO(2) increased during ECMO treatment (0.035 mmHg/L min(-1) (95 % confidence interval (CI) 0.015-0.055) P < 0.001, and 2.19 % (0.92-3.46) P = 0.009), but these changes were unrelated to wet prime time. Conclusion: Wet pre-priming of ECMO circuits for up to 57 days did not affect oxygenator function. The low incidence of bacterial growth (1.9 %) suggests that pre-primed ECMO generally maintain sterility and can facilitate rapid ECPR initiation. However, bacterial growth highlights the need for caution in non-urgent cases. Culturing the circuit at initiation can mitigate this risk.
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| 4. |
- Bragadottir, Gudrun, et al.
(författare)
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Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury - true GFR versus urinary creatinine clearance and estimating equations.
- 2013
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Ingår i: Critical care (London, England). - : Springer Science and Business Media LLC. - 1466-609X .- 1364-8535. ; 17:3
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Estimation of kidney function in critically ill patients with acute kidney injury (AKI), is important for appropriate dosing of drugs and adjustment of therapeutic strategies, but challenging due to fluctuations in kidney function, creatinine metabolism and fluid balance. Data on the agreement between estimating and gold standard methods to assess glomerular filtration rate (GFR) in early AKI are lacking. We evaluated the agreement of urinary creatinine clearance (CrCl) and three commonly used estimating equations, the Cockcroft Gault (CG), the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, in comparison to GFR measured by the infusion clearance of 51Cr-EDTA, in critically ill patients with early AKI after complicated cardiac surgery. METHODS: Thirty patients with early AKI were studied in the intensive care unit, 2 to 12 days after complicated cardiac surgery. Infusion clearance for Chromium-ethylenediaminetetraacetic acid (51Cr-EDTA) was obtained as a measure of GFR (GFR51Cr-EDTA) calculated from the formula; GFR (mL/min/1.73m2) = (51Cr-EDTA infusion rate x 1.73) / (arterial 51Cr-EDTA x BSA) and compared with the urinary CrCl and the estimated GFR (eGFR) from the three estimating equations. Urine was collected in two 30 min periods to measure urine flow and urine creatinine. Urinary CrCl was calculated from the formula; CrCl (mL/min/1.73m2) = (urine volume x urine creatinine x 1.73) / (serum creatinine x 30min x BSA). RESULTS: The within-group error was lower for GFR51Cr-EDTA than the urinary CrCl method, 7.2 %. vs. 55.0 %. The between-method bias was 2.6, 11.6, 11.1 and 7.39 ml/min, for eGFRCrCl, eGFRMDRD , eGFRCKD-EPI and eGFRCG , respectively, when compared to GFR51Cr-EDTA. The error was 103, 68.7, 67.7 and 68.0 % for eGFRCrCl, eGFRMDRD, eGFRCKD-EPI and eGFRCG, respectively when compared to GFR51Cr-EDTA. CONCLUSIONS: The study demonstrated a poor precision of the commonly utilized urinary CrCl method for assessment of GFR in critically ill patients with early AKI and should not be used as a reference method when validating new methods for assessing kidney function in this patient population. The commonly used estimating equations perform poorly, when estimating GFR, with high biases and unacceptably high errors.
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| 5. |
- Bragadottir, Gudrun, et al.
(författare)
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Effects of Levosimendan on Glomerular Filtration Rate, Renal Blood Flow, and Renal Oxygenation After Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Placebo-Controlled Study.
- 2013
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Ingår i: Critical care medicine. - 1530-0293. ; 41:10, s. 2328-2335
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Tidskriftsartikel (refereegranskat)abstract
- Acute kidney injury develops in a large proportion of patients after cardiac surgery because of the low cardiac output syndrome. The inodilator levosimendan increases cardiac output after cardiac surgery with cardiopulmonary bypass, but a detailed analysis of its effects on renal perfusion, glomerular filtration, and renal oxygenation in this group of patients is lacking. We therefore evaluated the effects of levosimendan on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen demand/supply relationship, i.e., renal oxygen extraction, early after cardiac surgery with cardiopulmonary bypass.
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| 6. |
- Bragadottir, Gudrun, et al.
(författare)
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Low-dose vasopressin increases glomerular filtration rate, but impairs renal oxygenation in post-cardiac surgery patients.
- 2009
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Ingår i: Acta Anaesthesiol Scand. - : Wiley. - 1399-6576. ; 53:8, s. 1052-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The beneficial effects of vasopressin on diuresis and creatinine clearance have been demonstrated when used as an additional/alternative therapy in catecholamine-dependent vasodilatory shock. A detailed analysis of the effects of vasopressin on renal perfusion, glomerular filtration, excretory function and oxygenation in man is, however, lacking. The objective of this pharmacodynamic study was to evaluate the effects of low to moderate doses of vasopressin on renal blood flow (RBF), glomerular filtration rate (GFR), renal oxygen consumption (RVO2) and renal oxygen extraction (RO2Ex) in post-cardiac surgery patients. METHODS: Twelve patients were studied during sedation and mechanical ventilation after cardiac surgery. Vasopressin was sequentially infused at 1.2, 2.4 and 4.8 U/h. At each infusion rate, systemic haemodynamics were evaluated by a pulmonary artery catheter, and RBF and GFR were measured by the renal vein thermodilution technique and by renal extraction of 51chromium-ethylenediaminetetraacetic acid, respectively. RVO2 and RO2Ex were calculated by arterial and renal vein blood samples. RESULTS: The mean arterial pressure was not affected by vasopressin while cardiac output and heart rate decreased. RBF decreased and GFR, filtration fraction, sodium reabsorption, RVO2, RO2Ex and renal vascular resistance increased dose-dependently with vasopressin. Vasopressin exerted direct antidiuretic and antinatriuretic effects. CONCLUSIONS: Short-term infusion of low to moderate, non-hypertensive doses of vasopressin induced a post-glomerular renal vasoconstriction with a decrease in RBF and an increase in GFR in post-cardiac surgery patients. This was accompanied by an increase in RVO2, as a consequence of the increases in the filtered tubular load of sodium. Finally, vasopressin impaired the renal oxygen demand/supply relationship.
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| 7. |
- Bragadottir, Gudrun, et al.
(författare)
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Mannitol increases renal blood flow and maintains filtration fraction and oxygenation in postoperative acute kidney injury: a prospective interventional study.
- 2012
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 16:4
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: INTRODUCTION: Acute kidney injury (AKI), which is a major complication after cardiovascular surgery, is associated with significant morbidity and mortality. Diuretic agents are frequently used to improve urine output, and to facilitate fluid management in these patients. Mannitol, an osmotic diuretic, is used in the perioperative setting in the belief that it exerts reno-protective properties. In a recent study on uncomplicated post-cardiac surgery patients with normal renal function, mannitol increased glomerular filtration rate (GFR), possibly by a de-swelling effect on tubular cells. Furthermore, experimental studies have previously shown that renal ischemia causes an endothelial cell injury and dysfunction followed by endothelial cell oedema. We studied the effects of mannitol on renal blood flow (RBF), glomerular filtration rate (GFR), renal oxygen consumption (RVO2) and extraction (RO2Ex) in early, ischaemic AKI after cardiac surgery. METHODS: Eleven patients with AKI were studied during propofol sedation and mechanical ventilation 2-6 days after complicated cardiac surgery. All patients had severe heart failure treated with one (100%) or two (73%) inotropic agents and intra-aortic balloon pump (36%). Systemic haemodynamics were measured by a pulmonary artery catheter. RBF and renal filtration fraction (FF) were measured by the renal vein thermo-dilution technique and by renal extraction of chromium-51- ethylenediaminetetraacetic acid (51Cr-EDTA), respectively. GFR was calculated as the product of FF and renal plasma flow RBF x (1-hematocrit). RVO2 and RO2Ex were calculated from arterial and renal vein blood samples according to standard formulae. After control measurements, a bolus dose of mannitol 225 mg/kg, was given followed by an infusion at a rate of 75 mg/kg/h for two 30-minute periods. RESULTS: Mannitol did not affect cardiac index or cardiac filling pressures. Mannitol increased urine flow by 61% (P<0.001). This was accompanied by a 12% increase in RBF (P<0.05) and 13% decrease in renal vascular resistance (P<0.05). Mannitol increased the RBF/cardiac output (CO) relationship (P=0.040). Mannitol caused no significant changes in RO2Ext or renal FF. CONCLUSIONS: Mannitol treatment of postoperative AKI induces a renal vasodilation and redistributes systemic blood flow to the kidneys. Mannitol does not affect filtration fraction or renal oxygenation, suggestive of balanced increases in perfusion/filtration and oxygen demand/supply.
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| 8. |
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| 9. |
- Drevinge, Christina, 1983, et al.
(författare)
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Perilipin 5 is protective in the ischemic heart
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 219, s. 446-454
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Tidskriftsartikel (refereegranskat)abstract
- Background: Myocardial ischemia is associated with alterations in cardiac metabolism, resulting in decreased fatty acid oxidation and increased lipid accumulation. Here we investigate how myocardial lipid content and dynamics affect the function of the ischemic heart, and focus on the role of the lipid droplet protein perilipin 5 (Plin5) in the pathophysiology of myocardial ischemia. Methods and results: We generated Plin5(-/-) mice and found that Plin5 deficiency dramatically reduced the triglyceride content in the heart. Under normal conditions, Plin5(-/-) mice maintained a close to normal heart function by decreasing fatty acid uptake and increasing glucose uptake, thus preserving the energy balance. However, during stress or myocardial ischemia, Plin5 deficiency resulted in myocardial reduced substrate availability, severely reduced heart function and increased mortality. Importantly, analysis of a human cohort with suspected coronary artery disease showed that a common noncoding polymorphism, rs884164, decreases the cardiac expression of PLIN5 and is associated with reduced heart function following myocardial ischemia, indicating a role for Plin5 in cardiac dysfunction. Conclusion: Our findings indicate that Plin5 deficiency alters cardiac lipid metabolism and associates with reduced survival following myocardial ischemia, suggesting that Plin5 plays a beneficial role in the heart following ischemia. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.
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| 10. |
- Granklint Enochson, Pernilla, 1965-
(författare)
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Om organsystemens organisation och funktion : analys av elevsvar från Sverige och Sydafrika
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med denna avhandling är att studera svenska och sydafrikanska elevers föreställningar om kroppens byggnad och funktion, samt hur dessa föreställningar påverkar närliggande frågeställningar. Datainsamling har skett genom att flera olika typer av enkäter samt intervjuer använts. Samtliga elever som deltog gick i årskurs nio. Det var 88 elever i den svenska och 166 i den Sydafrikanska datainsamlingen.Resultaten visar att elever har en god förmåga att beskriva matspjälkningssystemet då de beskriver en smörgås väg genom kroppen, och de visar även god förmåga att koppla samman blodsystemet till matspjälkningsorganen för detta scenario. Däremot har eleverna svårigheter att överföra denna kunskap till ett nytt sammanhang då de skulle beskriva en värktabletts väg genom kroppen. Eleverna hade inte fått undervisning om värktablettens väg genom kroppen, så detta var ett nytt sammanhang för dem. Det visade sig vara än svårare för eleverna att koppla samman ytterligare ett organsystem, det vill säga urinorganen, när de skulle beskriva vattnets väg genom kroppen. Trots att urinorganen finns beskrivna i läroboken och eleverna hade fått undervisning om dessa. Det fanns också elever som visade icke vetenskapligt vedertagna modeller och beskrev vattnets väg genom kroppen genom att rita ett rör direkt från halsen till njuren. Dessa elever kunde inte beskriva njuren främsta funktion som är att rena blodet. En liknande studie genomfördes i fem Sydafrikanska skolor och det visade sig att den i Sverige, och i andra europeiska studier, vanliga icke vetenskapliga förklaringen med en direktkoppling mellan matspjälkningsorganen och njurarna var mycket ovanlig bland dessa elever. Nästan hälften av de sydafrikanska eleverna visade istället en föreställning om att vattnet passerar lungorna på sin väg till magsäcken. Det fanns även mindre mängd elever som även ansåg att maten skulle passera lungorna innan magsäcken. När det gäller vattenfrågan har en djupare analys gjorts på 5 av de svenska elevernas enkät- och intervjusvar. Det visade sig att elevernas föreställningar antingen var desamma eller förändrades till en mindre sofistikerad förklaringsmodell mellan enkät och intervjusvar då det gällde vattnets väg genom kroppen, detta skiljer sig från frågeställningen med smörgåsen där intervjun visade på liknande eller bättre resultat.
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