| 1. |
- May, Teresa L., et al.
(författare)
-
Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest : analysis of International Cardiac Arrest Registry
- 2019
-
Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 45:5, s. 637-646
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeFunctional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers.MethodsAnalysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average.ResultsA total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 degrees C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers.ConclusionsCenter-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.
|
|
| 2. |
- Swärd, Kristina, 1953, et al.
(författare)
-
Bedside estimation of absolute renal blood flow and glomerular filtration rate in the intensive care unit. A validation of two independent methods.
- 2004
-
Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 30:9, s. 1776-82
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate various treatment strategies in critically ill patients with ischaemic acute renal failure, there is a need for reliable bedside measurements of total renal blood flow (RBF), glomerular filtration rate (GFR) and renal oxygen consumption without the need for urine collection. DESIGN: The continuous renal vein thermodilution method and the infusion clearance techniques were validated against the gold standard technique, the urinary clearance of paraaminohippurate (PAH) and chromium ethylenediaminetetraacetic acid, respectively. SETTING: University hospital cardiothoracic ICU. PATIENTS: Seventeen uncomplicated mechanically ventilated post-cardiac surgical patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Renal blood flow, GFR and the renal filtration fraction (FF) were measured for two consecutive 30-min periods by urinary clearance and compared with simultaneous measurements made by the thermodilution and infusion clearance techniques. Urinary clearance for PAH was corrected for by renal extraction of PAH. The within-group error, repeatability coefficient and the coefficient of variation were highest for the thermodilution technique and lowest for the infusion clearance technique with regard to RBF, GFR and FF. The infusion clearance technique had a higher agreement with the urinary clearance method than the thermodilution method. For estimations of RBF and GFR, the between-group errors were 33% and 43% comparing infusion clearance with urinary clearance and 65% and 67% comparing thermodilution with urinary clearance. CONCLUSIONS: The infusion clearance method had the highest reproducibility and the highest agreement with the urinary clearance reference method. The renal vein thermodilution technique is less reliable in the ICU setting due to poor repeatability and poor agreement with the reference method.
|
|
| 3. |
- Swärd, Kristina, 1953, et al.
(författare)
-
Differential effects of human atrial natriuretic peptide and furosemide on glomerular filtration rate and renal oxygen consumption in humans.
- 2005
-
Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 31:1, s. 79-85
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Imbalance in the renal medullary oxygen supply/demand relationship can cause hypoxic medullary damage and ischemic acute renal failure. Human atrial natriuretic peptide (h-ANP) increases glomerular filtration rate in clinical acute renal failure. This would increase renal oxygen consumption due to increased tubular load of sodium. Loop diuretics are commonly used in acute renal failure. Data on the effects of loop diuretics on glomerular filtration rate and renal oxygen consumption in humans are, however, controversial. We evaluated the effects of h-ANP and furosemide on renal oxygen consumption, glomerular filtration rate, and renal hemodynamics in humans. DESIGN AND SETTING: Prospective two-agent interventional study in a university hospital cardiothoracic ICU. PATIENTS: Nineteen uncomplicated, mechanically ventilated postcardiac surgery patients with normal renal function. INTERVENTIONS: h-ANP (25 and 50 ng/kg per minute, n=10) or furosemide (0.5 mg/kg per hour, n=9). MEASUREMENTS AND RESULTS: Renal plasma flow and glomerular filtration rate were measured using the infusion clearance technique for (51)Cr-labeled EDTA and paraaminohippurate, corrected for by renal extraction of PAH. h-ANP increased glomerular filtration rate, renal filtration fraction, fractional excretion of sodium, and urine flow. This was accompanied by an increase in tubular sodium reabsorption (9%) and renal oxygen consumption (26%). Furosemide infusion caused a 10- and 15-fold increase in urine flow and fractional excretion of sodium, respectively, accompanied by a decrease in tubular sodium reabsorption (-28%), renal oxygen consumption (-23%), glomerular filtration rate and filtration fraction (-12% and -7%, respectively). CONCLUSIONS: The filtered load of sodium is an important determinant of renal oxygen consumption. h-ANP improves glomerular filtration rate but does not have energy-conserving tubular effects. In contrast, furosemide decreases tubular sodium reabsorption and renal oxygen consumption and thus has the potential to improve the oxygen supply/demand relationship in clinical ischemic acute renal failure.
|
|
| 4. |
- Swärd, Kristina, 1953, et al.
(författare)
-
Recombinant human atrial natriuretic peptide in ischemic acute renal failure: a randomized placebo-controlled trial.
- 2004
-
Ingår i: Critical care medicine. - 0090-3493. ; 32:6, s. 1310-5
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Acute renal failure is associated with significant morbidity and mortality rates. Need for dialysis is an independent risk factor for early mortality after complicated cardiac surgery. Human atrial natriuretic peptide (h-ANP) is a potent endogenous natriuretic and diuretic substance. Exogenous administration of h-ANP increases glomerular filtration rate and renal blood flow in clinical acute renal failure. We have studied the effects of h-ANP on renal outcome in ischemic acute renal failure. DESIGN: A prospective, double-blind, randomized, placebo-controlled study. SETTING: Cardiothoracic intensive care units of two tertiary care centers. PATIENTS: Sixty-one patients with normal preoperative renal function suffering from postcardiac surgical heart failure requiring significant inotropic and vasoactive support. INTERVENTIONS: The patients were randomized to receive a continuous infusion of either recombinant h-ANP (50 ng.kg(-1).min(-1)) or placebo when serum creatinine increased by >50% from baseline. The treatment with h-ANP/placebo continued until serum creatinine decreased below the trigger value for inclusion or the patients fulfilled predefined criteria for dialysis. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was dialysis on or before day 21 after the start of treatment. Secondary renal outcome variables were dialysis-free survival at day 21 and creatinine clearance. Twenty-nine patients were assigned h-ANP and 30 placebo. Six (21%) patients in the h-ANP group compared with 14 (47%) in the placebo group needed dialysis before or at day 21 (hazard ratio, 0.28; 95% confidence interval, 0.10-0.73; p =.009). Eight (28%) patients in the h-ANP group compared with 17 (57%) in the placebo group suffered from the combined end point dialysis or death before or at day 21 (hazard ratio, 0.35; 95% confidence interval, 0.14-0.82; p =.017). h-ANP improved creatinine clearance in contrast to placebo (p =.040). CONCLUSIONS: Infusion of h-ANP at a rate of 50 ng.kg(-1).min(-1) enhances renal excretory function, decreases the probability of dialysis, and improves dialysis-free survival in early, ischemic acute renal dysfunction after complicated cardiac surgery.
|
|
