| 1. |
- Dalla, Keti, 1975, et al.
(författare)
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Speckle tracking-vs conventional echocardiography for the detection of myocardial injury-A study on patients with subarachnoid haemorrhage.
- 2019
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 63:3, s. 365-372
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Tidskriftsartikel (refereegranskat)abstract
- Myocardial injury with regional wall motion abnormalities (RWMA) is common in subarachnoid haemorrhage (SAH). We hypothesized that the diagnostic performance of left ventricular (LV) global and regional longitudinal strain (GLS and RLS, respectively), assessed with speckle tracking echocardiography is superior to standard echocardiography for the detection of myocardial injury in SAH.Seventy-one unselected patients with verified SAH were included. Echocardiography was performed within 48hours after admission. hsTnT was followed daily up to 3days post-admission. RWMA, LV ejection fraction (LVEF), GLS and RLS were analysed by two experienced echocardiographists, blinded to the information on plasma hsTnT. A reduced GLS was defined as >-15%. Two cut-off levels were used for the definition of RLS, ie when segmental strain was >-15% (liberal) or >-11% (conservative) in ≥2 adjacent segments. Myocardial injury was defined as a peak hsTnT ≥90ng/L.The incidence of myocardial injury was 25%. The hsTnT (median, 25% and 75% percentile) in patients with (a) reduced LV ejection fraction (LVEF <50%, n=10) was 502 (175-718), (b) RWMA (n=12) was 648 (337-750), (c) reduced GLS (n=12) was 502 (132-750) and (d) reduced RLS (n=42) was 40 (10-216), respectively. The specificity/sensitivity for LVEF, RWMA, GLS and RLS to detect myocardial injury 98%/50%, 100%/67%, 96%/56% and 54%/94%, respectively. The intra- and inter-observer variability for assessment of RLS was high.The diagnostic performance of GLS by strain imaging is not superior to standard echocardiography for the detection of myocardial injury in SAH. RLS could not reliably detect regional myocardial injury.
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| 2. |
- Bjerkne Wenneberg, Sandra, et al.
(författare)
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Association between inflammatory response and outcome after subarachnoid haemorrhage.
- 2021
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 143:2, s. 195-205
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Tidskriftsartikel (refereegranskat)abstract
- Recent reports suggest an association between the inflammatory response after aneurysmal subarachnoid haemorrhage (aSAH) and patients' outcome. The primary aim of this study was to identify a potential association between the inflammatory response after aSAH and 1-year outcome. The secondary aim was to investigate whether the inflammatory response after aSAH could predict the development of delayed cerebral ischaemia (DCI).This prospective observational pilot study included patients with an aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, between May 2015 and October 2016. The patients were stratified according to the extended Glasgow Outcome Scale (GOSE) as having an unfavourable (score: 1-4) or favourable outcome (score: 5-8). Furthermore, patients were stratified depending on development of DCI or not. Patient data and blood samples were collected and analysed at admission and after 10days.Elevated serum concentrations of inflammatory markers such as tumour necrosis factor-α and interleukin (IL)-6, IL-1Ra, C-reactive protein and intercellular adhesion molecule-1 were detected in patients with unfavourable outcome. When adjustments for Glasgow coma scale were made, only IL-1Ra remained significantly associated with poor outcome (p=0.012). The inflammatory response after aSAH was not predictive of the development of DCI.Elevated serum concentrations of inflammatory markers were associated with poor neurological outcome 1-year after aSAH. However, inflammatory markers are affected by many clinical events, and when adjustments were made, only IL-1Ra remained significantly associated with poor outcome. The robustness of these results needs to be tested in a larger trial.
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| 3. |
- Bjerkne Wenneberg, Sandra, et al.
(författare)
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Heart rate variability monitoring for the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
- 2020
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 64:7, s. 945-952
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Tidskriftsartikel (refereegranskat)abstract
- Delayed cerebral ischemia (DCI) is a major cause of impaired outcome after aneurysmal subarachnoidal hemorrhage (aSAH). In this observational cohort study we investigated whether changes in heart rate variability (HRV) that preced DCI could be detected.Sixty-four patients with aSAHwere included. HRV data were collected for up to 10 days and analyzed off-line.Correlationwith clinical status and/or radiologic findings was investigated. A linear mixed model was used for the evaluation of HRVparameters over time in patients with and without DCI. Extended Glascow outcome scale score was assessed after 1 year.In 55 patients HRV data could be analysed. Fifteen patients developed DCI. No changes in HRV parameters were observed 24 h before onset of DCI. Mean of the HRV parameters in the first 48 h did not correlate with the development of DCI. Low/high frequency (LF/HF) ratio increased more in patients developing DCI (β -0.07 (95% confidence interval,0.12-0.01);p=0.012). Lower STRDRR (standard deviation of RR intervals), RMSSD (root mean square of the successive differences between adjacent RR intervals),and total power(p=0.003, p=0.007 and p=0.004respectively) in the first 48 h was seen in patients who died within 1 year.Impaired HRV correlated with 1-year mortality and LF/HF ratio increased more in patients developing DCI. Even though DCI could not be detected by the intermittent analysis of HRV used in this study, continuous HRV monitoring may have potential in the detection of DCI after aSAH using different methods of analysis.
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| 4. |
- Bjerkne Wenneberg, Sandra, et al.
(författare)
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Long-term outcomes after aneurysmal subarachnoid hemorrhage: A prospective observational cohort study
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 525-536
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The survival rates for patients affected by aneurysmal subarachnoid hemorrhage (aSAH) have increased in recent years; however, many patients continue to develop cognitive dysfunctions that affect their quality of life. The commonly used outcome measures often fail to identify these cognitive dysfunctions. This study aimed to evaluate the long-term outcomes at 1 and 3 years after aSAH to assess changes over time and relate outcomes to patient characteristics and events during the acute phase. Materials and Methods This prospective observational study included patients that experienced aSAH. Patients were assessed according to the extended Glasgow Outcome Scale, Life Satisfaction Questionnaire, Mayo-Portland Adaptability inventory-4, and Mental Fatigue scale. Results Patients were assessed after 1 year (n = 62) and 3 years (n = 54). At 3 years, the extended Glasgow Outcome Scale score improved in 15% and worsened in 12% of the patients. Mental fatigue was observed in 57% of the patients at 1 year. Patients <60 years of age at the time of aSAH had more self-assessed problems, including pain/headache (p < .01), than patients >60 years of age. Patients with delayed cerebral ischemia during the acute phase reported more dissatisfaction at 3 years, whereas no significant result was seen at 1 year. Conclusions Cognitive dysfunction, especially mental fatigue, is common in patients with aSAH, which affects quality of life and recovery. Patient outcome is a dynamic process developing throughout years after aSAH, involving both improvement and deterioration. This study indicates the importance of longer follow-up periods with broad outcome assessments.
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| 5. |
- Block, Linda, et al.
(författare)
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Age, SAPS 3 and female sex are associated with decisions to withdraw or withhold intensive care
- 2019
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 63:9, s. 1210-1215
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care. Methods: Registry study using data from the Swedish Intensive Care Registry (SIR) 2014-2016. Age, condition at admission, including co-morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group. Results: Of all 97095 cases, 47.1% were 61-80 years old, 41.9% were women and 58.1% men. 14996 (15.4%) were allocated to the WW group and 82149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P < 0.001), had higher SAPS 3 (P < 0.001) and were predominantly female (P < 0.001). Compared to patients 16-20 years old, patients >81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084-1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13- 1.23). Conclusion: Older age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care. © 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd
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| 6. |
- Block, Linda, et al.
(författare)
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Cerebral ischemia detection using artificial intelligence (CIDAI)-A study protocol
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 64:9, s. 1335-1342
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Tidskriftsartikel (refereegranskat)abstract
- Background The onset of cerebral ischemia is difficult to predict in patients with altered consciousness using the methods available. We hypothesize that changes in Heart Rate Variability (HRV), Near-Infrared Spectroscopy (NIRS), and Electroencephalography (EEG) correlated with clinical data and processed by artificial intelligence (AI) can indicate the development of imminent cerebral ischemia and reperfusion, respectively. This study aimed to develop a method that enables detection of imminent cerebral ischemia in unconscious patients, noninvasively and with the support of AI. Methods This prospective observational study will include patients undergoing elective surgery for carotid endarterectomy and patients undergoing acute endovascular embolectomy for cerebral arterial embolism. HRV, NIRS, and EEG measurements and clinical information on patient status will be collected and processed using machine learning. The study will take place at Sahlgrenska University Hospital, Gothenburg, Sweden. Inclusion will start in September 2020, and patients will be included until a robust model can be constructed. By analyzing changes in HRV, EEG, and NIRS measurements in conjunction with cerebral ischemia or cerebral reperfusion, it should be possible to train artificial neural networks to detect patterns of impending cerebral ischemia. The analysis will be performed using machine learning with long short-term memory artificial neural networks combined with convolutional layers to identify patterns consistent with cerebral ischemia and reperfusion. Discussion Early signs of cerebral ischemia could be detected more rapidly by identifying patterns in integrated, continuously collected physiological data processed by AI. Clinicians could then be alerted, and appropriate actions could be taken to improve patient outcomes.
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| 7. |
- Cederwall, Carl-Johan, et al.
(författare)
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Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey.
- 2023
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Ingår i: Intensive & critical care nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 74
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Tidskriftsartikel (refereegranskat)abstract
- To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7days.We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n=79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics.We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units.We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.
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| 8. |
- Cederwall, Carl-Johan, et al.
(författare)
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Prevalence and Intensive Care Bed Use in Subjects on Prolonged Mechanical Ventilation in Swedish ICUs
- 2021
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Ingår i: Respiratory Care. - : Daedalus Enterprises. - 0020-1324 .- 1943-3654. ; 66:2, s. 300-306
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The number of patients requiring prolonged mechanical ventilation (PMV) is predicted to escalate due to an aging population. International studies on prevalence and resource utilization of this patient group exist, but data are lacking from Scandinavian ICUs, where there is a relatively low number of ICU beds in relation to population. The primary aim was to identify prevalence of admissions requiring mechanical ventilation >= 7-21 d and PMV > 21 d, and their use of ICU bed days in Sweden. Secondary aims were to describe patient characteristics and outcomes. METHODS: We obtained data from the Swedish Intensive Care Registry on admissions age >= 18 y mechanically ventilated >= 7 d and used open source registry data to calculate the prevalence and use of bed days of admissions ventilated >= 7-21 d and PMV > 21 d. RESULTS: Of the 39,510 ICU admissions to Swedish ICUs in 2017, those mechanically ventilated >= 7-21 d accounted for 1,643 (4%) admissions, and those with PMV > 21 d accounted for 307 (0.8%) admissions. Of the 109,457 ICU bed days, 22% were consumed by admissions ventilated >= 7-21 d and 10% by those with PMV > 21 d. The ICU mortality of both groups was 21%. Admissions with mechanical ventilation >= 7 d had a median age of 65 y and were predominantly male (64%). CONCLUSIONS: Admissions to Swedish ICUs who required mechanical ventilation >= 7-21 d and PMV > 21 d form a relatively small proportion of all ICU admissions, but consume a significant proportion of ICU beds days. Prevalence of admissions, ICU bed days, and ICU mortality were lower than reports from other countries, but the admissions were predominantly elderly and male, in accordance with other reports.
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Lambert, G, et al.
(författare)
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Sympathetic nervous activation following subarachnoid hemorrhage: Influence of intravenous clonidine.
- 2002
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Ingår i: Acta anaesthesiologica Scandinavica. - 0001-5172. ; 46:2, s. 160-5
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Tidskriftsartikel (refereegranskat)abstract
- Subarachnoid hemorrhage is often accompanied by systemic complications and cerebral vasospasm. Elevated levels of circulating catecholamines may be involved in the pathophysiology behind these events. The alpha-2-agonist clonidine inhibits sympathetic outflow by a central mechanism. Unrestricted sympathoexcitation may be detrimental and administration of clonidine may be beneficial in these patients.
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| 13. |
- Lindgren, Cecilia, et al.
(författare)
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Cerebrospinal fluid lactate and neurological outcome after subarachnoid haemorrhage
- 2019
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Ingår i: Journal of Clinical Neuroscience. - : Elsevier BV. - 0967-5868 .- 1532-2653. ; 60, s. 63-67
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased lactate in cerebrospinal fluid (CSF) has been regarded as a marker for cerebral ischemia and damage in the central nervous system. The aim of this study was to evaluate if CSF-lactate was associated with; impaired cerebral circulation, outcome, sex, age, clinical condition or treatment after subarachnoid haemorrhage (SAH). Methods: This study consists of 33 patients (22 females, 11 males) with aneurysmal SAH treated at Umea university hospital 2008-2009. Samples were obtained from external ventricular catheters 0-240 h after SAH. Normal CFS-lactate was defined as 1.2-2-1 mmol/L. Hunt & Hess scale assessed clinical condition. Impaired cerebral circulation was evaluated by clinical examination, transcranial doppler, CT-scan, and cerebral angiography. Glasgow outcome scale (GOS) evaluated outcome. Results: Seventy-nine CSF-lactate samples were analysed. CSF-lactate >2.1 mmol/L was found in 25/33 (76%) patients and in 50/79 (63%) samples. No difference in CSF-lactate levels was found over time. No association was found between patients with CSF-lactate >2.1 mmol/L and; sex, severity of clinical condition, impaired cerebral circulation or outcome. CSF-lactate >2.1 mmol/L was more common in patients >= 61 years of age (p = 0.04) and in patients treated with endovascular coiling compared to surgical clipping (p = 0.0001). Conclusion: In patients with SAH, no association was found between increased CSF-lactate (>2.1 mmol/L) and severe clinical condition, impaired cerebral circulation or unfavourable outcome. Endovascular coiling and age >= 61 years was associated with CSF-lactate above >2.1 mmol/L. (C) 2018 Published by Elsevier Ltd.
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| 14. |
- Lindgren, Cecilia, et al.
(författare)
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Leptin levels after subarachnoid haemorrhage are gender dependent
- 2016
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Ingår i: Springerplus. - : Springer Science and Business Media LLC. - 2193-1801. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Subarachnoid hemorrhage (SAH) is a neurological disease where the majority of the patients are critically ill. The adipokine leptin has in cerebral emergencies been related to severity of disease and to adverse outcome. The aim of this study was to examine leptin levels over time after SAH and associations to gender, age, body mass index, severity of disease, parenteral lipids, systemic organ failure and outcome. Methods: Prospective observational study in 56 patients. Leptin was obtained 0-240 h after SAH, in 48 h intervals. Severity of disease was assessed with the Hunt and Hess score, organ failure with the sequential organ failure assessment score, and outcome with Glasgow outcome scale. Leptin levels in the SAH group were compared with controls from the same geographical area. Results: At admission, Leptin was significantly higher in SAH patients compared to controls, both in female (28.6 +/- 25.6 vs 13.0 +/- 2.3 ng/mL, p = 0.001) and male patients (13.3 +/- 8.4 vs 4.3 +/- 0.7 ng/mL, p = 0.001). Leptin levels remained stable over time. Female patients had significantly higher leptin levels than male patients, and deceased female patients had higher leptin levels than female survivors (85.5 +/- 20.5 vs 50.5 +/- 34.6, n = 4/35, p < 0.05). Leptin levels did not differ between male survivors and non-survivors. Leptin levels were not associated with severity of disease, organ failure or parenteral lipids. Conclusion: Leptin levels were significantly higher in both male and female patients compared to controls. Higher leptin levels were related to outcome and organ failure in women but not in men. When analysing leptin levels gender-related differences should be considered.
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| 15. |
- Lindgren, Cecilia, et al.
(författare)
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Long-term subarachnoid haemorrhage survivors still die due to cerebrovascular causes
- 2015
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Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 132:6, s. 410-416
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Subarachnoid haemorrhage (SAH) is associated with sympathetic nervous activation and inflammation. SAH could therefore theoretically be a risk factor for development of cardiovascular disease. The aim of this study was to investigate whether long-term (>/=1 year) SAH survivors had an increased risk of death due to cardiovascular causes. MATERIAL & METHODS: SAH patients >/=18 years treated at Umea University Hospital between 1986 and 2006 were eligible for inclusion. Deceased patients were identified in the Swedish population register. Death certificates from long-term SAH survivors and causes of death in the general population were obtained from the National Board of Health and Welfare, Sweden. The prevalence of comorbidities at the time of SAH was compared with the distribution of cardiovascular risk factors in the northern Sweden MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) health survey. Analyses were stratified for age and sex. RESULTS: In the SAH patients, the median year of SAH was 1992 and the median year of death was 2001. The MONICA survey in 1994 and the distribution of deaths in the general population in 2001 were used for comparison. Long-term SAH survivors had, compared to the general population, a significantly increased risk for death due to cerebrovascular disease (P < 0.0001), but not for death due to cardiovascular disease. Hypertension was more common in SAH patients compared to survey participants (P < 0.01). CONCLUSION: Cerebrovascular causes of death were significantly more common in long-term survivors after SAH compared to the general population.
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| 16. |
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| 17. |
- Naredi, Silvana, 1953
(författare)
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Cerebral circulation and the sympathetic nervous system in patients with traumatic brain injury or subarachnoid hemorrhage
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Maintenance of adequate cerebral microcirculation is necessary to avoid cerebral ischemia after severe traumatic brain injury and non-traumatic subarachnoid hemorrhage. After severe traumatic brain injury the blood-brain-barrier is disrupted and transcapillary leakage will contribute to the development of vasogenic brain edema. The edema causes a compromised microcirculation.Systemic complications and cerebral vasospasm observed after non-traumatic subarachnoid hemorrhage may be associated with an activated sympathetic nervous system. Although in-creased concentrations of plasma and urinary norepinephrine are found in patients following subarachnoid hemorrhage, this does not necessarily indicate an activated sympathetic nervous system. To adequately assess an activation of the sympathetic nervous system both release and removal processes of norepinephrine must be considered.A therapy focused on physiological principles for volume regulation and preserved microcir-culation following traumatic brain injury was evaluated in two clinical studies. Prostacyclin may improve cerebral microcirculation after severe traumatic brain injury due to its inhibition of platelet/leukocyte aggregation and adhesion to endothe-lium. Safety profile and outcome after prostacyclin administration was evaluated in the sec-ond study. With an isotope dilution technique the duration and magnitude of the sympathetic nervous activation in patients following subarachnoid hemorrhage was measured and the presumed inhibitory effect of clonidine on sympathetic nervous activation was tested.Favorable outcome after severe traumatic brain injury was 71% in both studies and the mor-tality rate was 13% and 3% respectively. Prostacyclin did not cause any severe side effects. Patients following subarachnoid hemorrhage exhibited an extreme elevation in sympathetic nervous system activity that persisted for at least one week after the insult. Contrary to what would be expected, clonidine did not reduce sympathetic nervous activation in patients fol-lowing subarachnoid hemorrhage.
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| 18. |
- Naredi, Silvana, 1953, et al.
(författare)
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Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage.
- 2000
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Ingår i: Stroke; a journal of cerebral circulation. - 0039-2499. ; 31:4, s. 901-6
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Tidskriftsartikel (refereegranskat)abstract
- Activation of the sympathetic nervous system, which leads to elevation of circulating catecholamines, is implicated in the genesis of cerebral vasospasm and cardiac aberrations after subarachnoid hemorrhage. To this juncture, sympathetic nervous testing has relied on indirect methods only.
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| 19. |
- Naredi, Silvana, 1953, et al.
(författare)
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Sympathetic activation and inflammatory response in patients with subarachnoid haemorrhage
- 2006
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Ingår i: Intensive Care Med. - 0342-4642. ; 32:12, s. 1955-61
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to evaluate the correlation between sympathetic nervous activation and the immune response in patients following subarachnoid haemorrhage (SAH). DESIGN AND SETTING: Clinical study in a neurosurgical intensive care unit. PATIENTS AND PARTICIPANTS: Fourteen patients with acute non-traumatic SAH were included. Fifteen healthy, age-matched volunteers served as controls for measurement of catecholamine spillover. INTERVENTION: Blood sampling for C3a, C5b-9, IL-6, IL-8 and norepinephrine kinetic determination was made within 48 h, at 72 h and on the 7th-10th day after the SAH. MEASUREMENTS AND RESULTS: SAH patients exhibited a profound increase in the rate of norepinephrine spillover to plasma at 48 h, 72 h and 7-10 days after the insult, 3-4 times that in healthy individuals. The plasma levels of C3a, IL-6 and C5b-9 were significantly elevated at 48 h, at 72 h and 7-10 days after the SAH, but the plasma level of IL-6 decreased significantly 7-10 days after the SAH. There was no relationship between the magnitude of sympathetic activation and the levels of inflammatory markers. CONCLUSIONS: Following SAH a pronounced activation of the sympathetic nervous system and the inflammatory system occurs. The lack of significant association between the rate of spillover of norepinephrine to plasma and the plasma levels of inflammatory markers indicates that the two processes, sympathetic activation and the immune response, following SAH are not quantitatively linked. In spite of a persistent high level of sympathetic activation the plasma level of IL-6 decreased significantly one week after SAH.
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| 20. |
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| 21. |
- Naredi, Silvana, 1953, et al.
(författare)
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Vasogenic edema and brain trauma.
- 1999
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Ingår i: Intensive Care Medicine. - 0342-4642 .- 1432-1238. ; 25, s. 244-245
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Forskningsöversikt (refereegranskat)
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| 22. |
- Nordenskjöld Syrous, Anna, et al.
(författare)
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Swedish intensivists' experiences and attitudes regarding end-of-life decisions
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 64:5, s. 656-62
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Tidskriftsartikel (refereegranskat)abstract
- Background To make end-of-life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists' experiences and attitudes regarding the decision-making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists' experiences, beliefs and attitudes regarding decision-making pertaining to EOL decisions. Second, we aimed to identify underlying factors that may contribute to variability in the decision-making process. Method This is a descriptive, qualitative study. Semi-structured interviews with nineteen intensivists from five different Swedish hospitals, with different ICU levels, were performed from 1 February 2017 to 31 May 2017. Results Intensivists strive to make end-of-life decisions that are well-grounded, based on sufficient information. Consensus with the patient, family and other physicians is important. Concurrently, decisions that are made with scarce information or uncertain medical prognosis, decisions made during on-call hours and without support from senior consultants cause concern for many intensivists. Underlying factors that contribute to the variability in decision-making are lack of continuity among senior intensivists, lack of needed support during on-call hours and disagreements with physicians from other specialties. There is also an individual variability primarily depending on the intensivist's personality. Conclusion Swedish intensivists' wish to make end-of-life decisions based on sufficient information, medically certain prognosis and consensus with the patient, family, staff and other physicians. Swedish intensivists' experience a variability in end-of-life decisions, which is generally accepted and not questioned.
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| 23. |
- Odenstedt Hergès, Helena, et al.
(författare)
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Machine learning analysis of heart rate variability to detect delayed cerebral ischemia in subarachnoid hemorrhage
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:2, s. 151-159
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Approximately 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) develop delayed cerebral ischemia (DCI). DCI is associated with increased mortality and persistent neurological deficits. This study aimed to analyze heart rate variability (HRV) data from patients with aSAH using machine learning to evaluate whether specific patterns could be found in patients developing DCI. Material & Methods This is an extended, in-depth analysis of all HRV data from a previous study wherein HRV data were collected prospectively from a cohort of 64 patients with aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, from 2015 to 2016. The method used for analyzing HRV is based on several data processing steps combined with the random forest supervised machine learning algorithm. Results HRV data were available in 55 patients, but since data quality was significantly low in 19 patients, these were excluded. Twelve patients developed DCI. The machine learning process identified 71% of all DCI cases. However, the results also demonstrated a tendency to identify DCI in non-DCI patients, resulting in a specificity of 57%. Conclusions These data suggest that machine learning applied to HRV data might help identify patients with DCI in the future; however, whereas the sensitivity in the present study was acceptable, the specificity was low. Possible confounders such as severity of illness and therapy may have affected the result. Future studies should focus on developing a robust method for detecting DCI using real-time HRV data and explore the limits of this technology in terms of its reliability and accuracy.
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| 24. |
- Pålsson, Paul, 1982, et al.
(författare)
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Physicians’ self-perceived preparedness for clinical supervision of medical students at university and non-university hospitals-results from a Swedish survey
- 2023
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Ingår i: BMC Medical Education. - 1472-6920. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The need for clinical placements outside traditional teaching hospitals for medical students is growing, both due to a decrease in hospital beds and the expansion of medical students. In this survey, distributed to supervisors at university and non-university hospitals, we investigated supervisors’ self-perceived preparedness for the training assignment and searched for factors associated with self-perceived pedagogical knowledge and familiarity with the students’ learning objectives. Methods: A pilot survey was developed using results from qualitative studies regarding clinical supervision of medical students and included questions on the supervisors’ education and preparation, if they were familiar with the students’ learning objectives, self-perceived pedagogical knowledge, and characteristics of the learning environment. The pilot survey was tested on a smaller group of supervisors. The results from the pilot survey were used to develop an e-survey that was distributed to all hospital employed physicians in Region Västra Götaland. Results: The survey was completed by 1732 physicians (response rate 43%). Among 517 respondents at the university hospital who reported activity as supervisor, 240 (46%) had attended preparatory supervisor training, 423 (82%) perceived enough pedagogical knowledge for the teaching assignment, and 391 (76%) reported familiarity with the learning objectives. The corresponding proportions at non-university hospitals were 159/485 (33%), 363/485 (75%), and 298/485 (61%), respectively (p ≤.007 all through, compared to the university hospital). Perceiving that goal description and written information from the course management was sufficient for being able to complete the training assignment showed strong association with both self-perceived pedagogical knowledge and familiarity with the students’ learning objectives. Conclusions: We found consistent differences between university and non-university hospitals with respect to the supervisors’ self-perceived preparedness for the training assignment. Efforts to convey the learning objectives and support to clinical supervisors are crucial for supervision of students at non-university hospitals.
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| 25. |
- Staron, Miroslaw, 1977, et al.
(författare)
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Robust machine learning in critical care - Software engineering and medical perspectives
- 2021
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Ingår i: Proceedings - 2021 IEEE/ACM 1st Workshop on AI Engineering - Software Engineering for AI, WAIN 2021. - : Institute of Electrical and Electronics Engineers Inc.. ; , s. 62-69
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Konferensbidrag (refereegranskat)abstract
- Using machine learning in clinical practice poses hard requirements on explainability, reliability, replicability and robustness of these systems. Therefore, developing reliable software for monitoring critically ill patients requires close collaboration between physicians and software engineers. However, these two different disciplines need to find own research perspectives in order to contribute to both the medical and the software engineering domain. In this paper, we address the problem of how to establish a collaboration where software engineering and medicine meets to design robust machine learning systems to be used in patient care. We describe how we designed software systems for monitoring patients under carotid endarterectomy, in particular focusing on the process of knowledge building in the research team. Our results show what to consider when setting up such a collaboration, how it develops over time and what kind of systems can be constructed based on it. We conclude that the main challenge is to find a good research team, where different competences are committed to a common goal.
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| 26. |
- Svendsen, P, et al.
(författare)
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Instillation of alcohol into venous malformations of the head and neck.
- 1994
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Ingår i: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi. - 0284-4311. ; 28:4, s. 279-84
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Tidskriftsartikel (refereegranskat)abstract
- Vascular malformations are errors of vascular morphogenesis, and must be differentiated from vascular tumours such as haemangiomas, because the natural history and treatment are different. Vascular malformations may be arteriovenous with high blood flow, or venous with low blood flow. Venous vascular malformations grow among soft tissues and are difficult to delineate at operation. Direct puncture under fluoroscopy with injection of contrast medium is one method of visualising the cavities of a venous malformation. Instillation of concentrated alcohol directly into such cavities is a possible treatment. Forty-four patients with venous malformations of the head or neck have been treated since 1984, of whom 31 responded to a follow up questionnaire. Twenty-three responded to injection of ethanol alone, and eight also required reconstructive surgery; 26 of the 31 described the result as "good" or "excellent" (84%).
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| 27. |
- Sörbo, Ann, 1955, et al.
(författare)
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Mental fatigue assessment may add information after aneurysmal subarachnoid hemorrhage
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- Background Mental fatigue, as part of cognitive dysfunction, has been reported to be common after subarachnoid hemorrhage and it significantly affects quality of life. Aims of the Study The aim of this study was to assess mental fatigue one year after an aneurysmal subarachnoid hemorrhage and to correlate the degree of mental fatigue to functional outcome assessed with the Extended Glasgow Outcome Scale (GOSE). Methods One year after an aneurysmal subarachnoid hemorrhage, the GOSE was assessed and a questionnaire for self-assessment of mental fatigue, the Mental Fatigue Scale, was distributed to all included patients. The maximum score is 42 and a score of >= 10.5 indicates mental fatigue. Results All patients with GOSE 8, indicating full recovery, had a mental fatigue score of <10.5. A linear correlation between the GOSE and the mental fatigue score was observed (p < 0.0001). Conclusions Patients with a favorable outcome and GOSE 5-7 could benefit from the assessments of mental fatigue in order to receive satisfactory rehabilitation.
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| 28. |
- Wahlström, Marie Rodling, 1960-, et al.
(författare)
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Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy--the Lund concept
- 2005
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Ingår i: Intensive Care Med. - Heidelberg : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 31:6, s. 832-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. DESIGN AND SETTING: A two-center retrospective study in neurointensive care units at university hospitals. PATIENTS: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. INTERVENTIONS: Treatment according to the principles of the Lund concept. MEASUREMENTS AND RESULTS: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. CONCLUSIONS: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed.
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