| 11. |
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| 12. |
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| 13. |
- Chen, Luni, 1962-
(författare)
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Inhaled Nitric Oxide Therapy : Non-response and Rebound Response
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Therapeutic inhaled nitric oxide (INO) has proved beneficial in patients with pulmonary hypertension. However, around 30-40% of the patients are non-responders to this therapy, and a life-threatening rebound response may occur during attempts to withdraw INO. This thesis investigated the link between vasoconstrictors and non- and rebound responses in piglets subjected to acute lung injury by exposure to endotoxin or oleic acid (OA). We found that INO had strong effect in mainly ET-1 related, endotoxin-induced pulmonary hypertension, and there was a rebound response after INO withdrawal. Thus, the weaker the response to INO, the greater the rebound. Neither response nor rebound was seen in oleic acid-induced, mainly prostaglandin related pulmonary hypertension. INO decreased expression of the ET-A receptor, and this might be another signal transduction pathway whereby INO relieves pulmonary vasoconstriction besides increasing c-GMP. Thus INO might have better effect in pulmonary vasoconstriction that is mainly mediated by ET-1 than when other vasoconstrictors are involved in the vascular reaction. Increased production and/or release of vasoconstrictor peptide endothelin-1 (ET-1) during INO, and release of prostaglandin TXA2 and PGF2α after INO withdrawal, were more important causes of the rebound, than a decreasing endogenous NO production during INO. The latter mechanism has been proposed in previous studies. An increase in prostaglandins after INO withdrawal is possibly secondary to the increase in ET-1 during INO. Combination of INO with the COX inhibitor diclofenac blocked the rebound reaction. These findings may open the way for new therapeutic modalities.
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| 14. |
- Ekman, Andreas, et al.
(författare)
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Reduction in the incidence of awareness using BIS monitoring
- 2004
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 48, s. 20-26
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Tidskriftsartikel (refereegranskat)abstract
- Reduction in the incidence of awareness using BISmonitoringA. EKMAN1,M-L.LINDHOLM1,C.LENNMARKEN2and R. SANDIN11Department of Anaesthesia and Intensive Care, Regional hospital, Kalmar, and The Karolinska Institute, Stockholm, and2Department ofAnaesthesia and Intensive Care, University Hospital, Linko¨ping, SwedenBackground: Explicit recall (ER) is evident i n a pproximat ely0.2% of patients given general anaesthesia including musclerelaxants. This prospective study was performed to evaluate ifcerebral monitoring using BIS to guide the conduction ofanaesthesia could reduce this incidence significantly.Patients and methods: A prospective cohort of 4945 consecutivesurgical patients requiring muscle relaxants and/or intubationwere monitored with BIS and subsequently interviewed for ERon three occasions. BIS values between 40 and 60 were recom-mended. The results from the BIS-monitored group of patientswas compared with a historical group of 7826 similar cases in aprevious study when no cerebral monitoring was used.Results: Two patients in th e BIS-monitored grou p, 0 .0 4% ,hadER as c ompared with 0.18% in the control group (P < 0.038).Both BIS-monitored patients with ER were aware during intub-ation when they had high BIS values (>60) for 4 min andmore than 10 min, respectively. However, periods with high BIS ¼ 4 min were al so eviden t in other patient s with no ER .Episodes with high BIS, 4 min or more, were found in 19% ofthe monitored patients during induction, and in 8% of casesduring maintenance.Conclusions: The use of BIS monitoring during general anaes-thesia requiring endotracheal intubation and/or muscle relax-ants was associated with a significantly reduced incidence ofawareness as compared with a historical control population.
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| 15. |
- Göthberg, Sylvia, 1953
(författare)
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New modes of improving ventilation and oxygenation in pulmonary hypertension and acute respiratory failure in newborns and children
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pulmonary hypertension leading to hypoxemia is a potentially life-threatening condition in pediatric intensive care. Hypoxemia may also result from conditions not primarily related to pulmonary hypertension. The pediatric patients with these symptoms are:· Children after surgery on cardiopulmonary bypass with pulmonary hypertension attributable to congenital heart defects with high pulmonary blood flow.· Newborns with persistent pulmonary hypertension as a symptom of fetal illness or malformation or after a relapse into fetal circulation without obvious reason.· Children with acute respiratory failure and disturbed vascular/alveolar relation with atelectases and ventilation/perfusion mismatch with major pulmonary shunt.New methods to provide better ventilation and oxygenation have been developed over the last few years. The aims of the present thesis were to assess:· The effect of inhaled nitric oxide (iNO), a selective pulmonary vasodilator, on pulmonary hypertension and oxygenation in dose-response studies.· The effect of high frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV) on alveolar recruitment and response to iNO.· Respiratory inductive plethysmography during dynamic ventilatory changes on high frequency oscillatory ventilation and on conventional ventilation (CV) as a new continuous and non-invasive method to optimize alveolar recruitment without interrupting ventilation.· Possible residual cardiopulmonary and neurological symptoms in a follow-up study after treatment with inhaled nitric oxide.The methods used were dose-response studies with iNO, lung volume recruitment with surfactant, high frequency oscillatory ventilation and partial liquid ventilation, lung volume measurements with respiratory inductive plethysmography and a four-center follow up study after iNO.Results and conclusions:· iNO decreased pulmonary artery pressure after cardiopulmonary bypass. No dose response relationship was found in the dose range of 3-80 ppm nitric oxide. Only a low dose of inhaled nitric oxide was needed, 5 ppm or less, which also concomitantly improved oxygenation in postoperative pulmonary hypertension in children.· iNO in doses up to 20 ppm immediately improved oxygenation in 68% of children with acute respiratory failure. Only 29% of non-responders survived and no delayed response was found in patients with acute respiratory failure. Non-responders need careful attention in order to improve ventilation and/or hemodynamics. Otherwise they should be transferred without delay to extracorporeal membrane oxygenation when eligible for such treatment.· Follow up after iNO treatment showed residual pulmonary hypertension in cardiac but not in lung patients. Residual respiratory disease and neurodevelopmental delay were not increased as compared with previous studies or owing to improved survival of severely ill patients.· In severe respiratory distress syndrome in preterm lambs, rescue treatment with alveolar recruitment strategies, HFOV and PLV, resulted in improved oxygenation. Alveolar recruitment was improved, as indicated by further improvement in oxygenation in response to iNO, particularly when HFOV and PLV were combined. Mean airway pressures on HFOV and CV when combined with PLV were significantly lower, reducing the risk of alveolar barotrauma.· Respiratory inductive plethysmography could be used to assess changes in lung volume during HFOV and CV in term and preterm lambs. This method provided the means to monitor and optimize lung volume continuously, non-invasively and without interruption of ventilation during mechanical ventilation. Observed changes in lung volume predicted changes in oxygenation.
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| 16. |
- Frid, Ingvar, 1945
(författare)
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Att uthärda det outhärdliga. Närståendes erfarenheter av dödförklaring med direkta dödskriterier
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Studies have demonstrated that close relatives find it difficult to understand the concept of brain death (BD), and to consider a human being as dead while the body continues to breathe. The information about BD can give rise to uncertainty and stress for the close relatives. Consequently, close relatives of the BD patient have been described as a family in crisis. The aim of this thesis is to illuminate the meaning of the close relatives experiences of being in and being confronted with a situation where BD is established. Both quantitative and qualitative methods were used. A retrospective study of medical records was carried out in order to elicit background data regarding the BD patient. A methodological study analysed the viability of using the narrative as a research method within nursing care. The narrative interview was chosen for studying the meaning of the personal experiences of close relatives who have experienced a situation of BD, and phenomenological hermeneutics were chosen for the interpretation of the narratives. The results showed that BD made up one in ten cases of death in the intensive care units studied. The patients fell suddenly ill, the majority died within 48 hours, and in 50% of cases a request for organ donation (OD) was made, 2/3 of which were granted. Only 1/3 of the close relatives were aware of the wishes of the deceased with regard to OD. The audio-taped narratives were interpreted with regard to their phenomenological hermeneutical content. Analysis of the plots contained in the narratives resulted in five themes: lack of preparedness; contradictory experiences of encounters with the carers; feeling abandoned; the missing farewell; living and working through the grief. Analysis of narrative sequences produced four main themes: the disquieting event; the uncertain vigil; the arduous struggle; and the difficult road ahead. Analysis of metaphors for BD showed a) two dimensions of the patient's body: presence and divisibility, and b) six themes: experiencing a chaotic unreality; experiencing an inner collapse; experiencing as a sense of forlornness; clinging to the hope of survival; being reconciled with the reality of death; and receiving caring which gives comfort. The comprehensive understanding was that the close relatives are struggling to be able to endure what is basically an unendurable situation. Unendurable by being impossible to endure, understand or accept. The close relative's struggle to endure is discussed in relation to selected theories on suffering and nursing care.
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| 17. |
- Huss, Fredrik, 1971-, et al.
(författare)
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Buses as fire hazards : A Swedish problem only? Suggestions for fire-prevention measures
- 2004
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Ingår i: Journal of Burn Care and Rehabilitation. - 0273-8481 .- 1534-5939. ; 25:4, s. 377-380
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, approximately 6% of all human transportation is made via buses. The Swedish Board of Accident Investigation and the Swedish Rescue Services Agency have pointed out repeatedly that buses are potential fire and burn hazards, not only when involved in collisions but also in other circumstances. The number of fire incidents is increasing, especially in newer buses. In conjunction with the Swedish Rescue Services Agency, we examined some of the recent bus fires in Sweden. We did not find any casualties, but the results of our study suggest that casualties as a result of bus fires are imminent unless preventive measures are taken. We also studied experiences from previous bus fires and suggest preventive measures.
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| 18. |
- NIlsson, Ulrica, 1960-, et al.
(författare)
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Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery : a randomized controlled trial
- 2003
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 47:3, s. 278-283
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study was designed to determine whether music (M), or music in combination with therapeutic suggestions (M/TS) could improve the postoperative recovery in the immediate post-operative in day care surgery.Method: One-hundred and eighty two unpremedicated patients who underwent varicose vein or open inguinal hernia repair surgery under general anesthesia were randomly assigned toa) listening to music, b) music in combination with therapeutic suggestions or c) blank tape in the immediate post-operative period. The surgical technique, anesthesia and postoperative analgesia were standardised. Analgesia, the total requirement of morphine, nausea, fatigue, well-being, anxiety, headache, urinary problems, heart rate and oxygen saturation were studied as outcome variables.Results: Pain intensity (VAS) was significantly lower (P=0.002) in the M (2.1) and the M/TS (1.9) group compared with the control group (2.9) and a higher oxygen saturation in M (99.2%) and M/TS (99.2%) group compared with the control (98.0%), P< 0.001, were found. No differences were noted in the other outcome variables.Conclusion: This controlled study has demonstrated that music with or without therapeutic suggestions in the early postoperative period has a beneficial effect on patients’ experience of analgesia. Although statistically significant the improvement in analgesia is modest in this group of patients with low overall pain levels.
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| 19. |
- Nilsson, Ulrica, 1960-, et al.
(författare)
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Improved recovery after music and therapeutic suggestions during general anaesthesia : a double-blind randomised controlled trial
- 2001
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 45:7, s. 812-817
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study was designed to determine whether music or music in combination with therapeutic suggestions in the intra-operative period under general anaesthesia could improve the recovery of hysterectomy patients.Methods: In a double-blind randomised clinical investigation, 90 patients who underwent hysterectomy under general anaesthesia were intra-operatively exposed to music, music in combination with therapeutic suggestion or operation room sounds. The anaesthesia was standardised. Postoperative analgesia was provided by a patient-controlled analgesia (PCA). The pain scores were recorded by means of a visual analogue scale. Nausea, emesis, bowel function, fatigue, well-being and duration of hospital stay were studied as outcome variables.Results: On the day of surgery, patients exposed to music in combination with therapeutic suggestions required less rescue analgesic compared with the controls. Patients in the music group experienced more effective analgesia the first day after surgery and could be mobilised earlier after the operation. At discharge from the hospital patients in the music and music combined with therapeutic suggestion group were less fatigued compared to the controls. No differences were noted in nausea, emesis, bowel function, well-being or length of hospital stay between the groups.Conclusion: This double-blind study has demonstrated that intra-operative music and music in combination with therapeutic suggestions may have some beneficial effects on postoperative recovery after hysterectomy. Further controlled studies are necessary to confirm our results.
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| 20. |
- Strömqvist, Björn, et al.
(författare)
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Ansiktsskydd for buklägesoperationer
- 2001
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Ingår i: Ortopediskt Magasin. - 0349-733X. ; :1, s. 18-18
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Tidskriftsartikel (populärvet., debatt m.m.)
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