| 1. |
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| 2. |
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| 3. |
- Broomé, Michael, et al.
(author)
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Pressure-independent cardiac effects of angiotensin II in pigs.
- 2004
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In: Acta Anaesthesiol Scand. - 0001-6772 .- 1365-201X. ; 182:2, s. 111-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: Angiotensin II (Ang II) is a potent vasoconstrictor with an important role in the development of cardiovascular disease. Earlier results have shown a positive acute inotropic effect of Ang II in anaesthetized pigs together with significant vasoconstriction. This investigation was designed to study cardiac effects of Ang II, when blood pressure was maintained constant by experimental means. METHODS: Ang II (200 microg h(-1)) was infused in anaesthetized pigs (n = 10) at two different arterial blood pressures, the first determined by the effects of Ang II alone, and the second maintained at baseline blood pressure with nitroprusside. Cardiac systolic and diastolic function was evaluated by analysis of left ventricular pressure-volume relationships. RESULTS: Heart rate, end-systolic elastance (Ees) and pre-load adjusted maximal power (PWRmax EDV(-2)) increased at both blood pressure levels, although less when blood pressure was kept constant with nitroprusside. The time constant for isovolumetric relaxation (tau(1/2)) was prolonged with Ang II alone and shortened with Ang II infused together with nitroprusside. CONCLUSION: Ang II infusion in the pig has inotropic and chronotropic properties independent of arterial blood pressure levels, although the effects seem to be blunted by pharmacological actions of the nitric oxide donor nitroprusside.
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| 4. |
- Fagerberg, Anneli, 1964, et al.
(author)
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Electrical impedance tomography and heterogeneity of pulmonary perfusion and ventilation in porcine acute lung injury.
- 2009
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 53:10, s. 1300-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: The heterogeneity of pulmonary ventilation (V), perfusion (Q) and V/Q matching impairs gas exchange in an acute lung injury (ALI). This study investigated the feasibility of electrical impedance tomography (EIT) to assess the V/Q distribution and matching during an endotoxinaemic ALI in pigs. METHODS: Mechanically ventilated, anaesthetised pigs (n=11, weight 30-36 kg) were studied during an infusion of endotoxin for 150 min. Impedance changes related to ventilation (Z(V)) and perfusion (Z(Q)) were monitored globally and bilaterally in four regions of interest (ROIs) of the EIT image. The distribution and ratio of Z(V) and Z(Q) were assessed. The alveolar-arterial oxygen difference, venous admixture, fractional alveolar dead space and functional residual capacity (FRC) were recorded, together with global and regional lung compliances and haemodynamic parameters. Values are mean+/-standard deviation (SD) and regression coefficients. RESULTS: Endotoxinaemia increased the heterogeneity of Z(Q) but not Z(V). Lung compliance progressively decreased with a ventral redistribution of Z(V). A concomitant dorsal redistribution of Z(Q) resulted in mismatch of global (from Z(V)/Z(Q) 1.1+/-0.1 to 0.83+/-0.3) and notably dorsal (from Z(V)/Z(Q) 0.86+/-0.4 to 0.51+/-0.3) V and Q. Changes in global Z(V)/Z(Q) correlated with changes in the alveolar-arterial oxygen difference (r(2)=0.65, P<0.05), venous admixture (r(2)=0.66, P<0.05) and fractional alveolar dead space (r(2)=0.61, P<0.05). Decreased end-expiratory Z(V) correlated with decreased FRC (r(2)=0.74, P<0.05). CONCLUSIONS: EIT can be used to assess the heterogeneity of regional pulmonary ventilation and perfusion and V/Q matching during endotoxinaemic ALI, identifying pivotal pathophysiological changes.
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| 5. |
- Fagerberg, Anneli, 1964, et al.
(author)
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Electrical impedance tomography applied to assess matching of pulmonary ventilation and perfusion in a porcine experimental model.
- 2009
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In: Critical care (London, England). - : Springer Science and Business Media LLC. - 1466-609X .- 1364-8535. ; 13:2
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Journal article (peer-reviewed)abstract
- Electrical impedance tomography (EIT) can be used to measure impedance changes related to the thoracic content of air and blood. Few studies, however, have utilised EIT to make concurrent measurements of ventilation and perfusion. This experimental study was performed to investigate the feasibility of EIT to describe ventilation/perfusion (V/Q) matching after acute changes of pulmonary perfusion and aeration.
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| 6. |
- Fagerberg, Anneli, 1964, et al.
(author)
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Monitoring pulmonary perfusion by electrical impedance tomography: an evaluation in a pig model.
- 2009
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 53:2, s. 152-8
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Journal article (peer-reviewed)abstract
- BACKGROUND: Electrical impedance tomography (EIT) is a non-invasive technique that generates images of impedance distribution. Changes in the pulmonary content of air and blood are major determinants of thoracic impedance. This study was designed to evaluate EIT in monitoring pulmonary perfusion in a wide range of cardiac output. METHODS: Eight anaesthetised, mechanically ventilated pigs were fitted with a 16-electrode belt at the mid-thoracic level to generate EIT images that were analysed to determine pulse-synchronous systolic changes in impedance (DeltaZ(sys)). Stroke volume (SV) was derived using a pulmonary artery catheter. Reductions in cardiac pre-load, and thus pulmonary perfusion, were induced either by inflating the balloon of a Fogarty catheter positioned in the inferior caval vein or by increasing the positive end-expiratory pressure (PEEP). All measurements were performed in a steady state during a short apnoea. RESULTS: Pulse-synchronous changes in DeltaZ(sys) were easily discernable during apnoea. Balloon inflation reduced SV to 36% of the baseline, with a corresponding decrease in DeltaZ(sys) to 45% of baseline. PEEP reduced SV and DeltaZ(sys) to 52% and 44% of the baseline, respectively. Significant correlations between SV and DeltaZ(sys) were demonstrated during all measurements (rho=0.62) as well as during balloon inflation (rho=0.73) and increased PEEP (rho=0.40). A Bland-Altman comparison of relative changes in SV and DeltaZ(sys) demonstrated a bias of -7%, with 95% limits of agreement at -51% and 36%. CONCLUSIONS: EIT provided beat-to-beat approximations of pulmonary perfusion that significantly correlated to a wide range of SV values achieved during both extra and intrapulmonary interventions to change cardiac output.
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| 7. |
- Frost, Steven A, et al.
(author)
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Unplanned admission to the intensive care unit in the very elderly and risk of in-hospital mortality.
- 2010
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In: Critical care and resuscitation. - 1441-2772. ; 12:3, s. 171-6
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Journal article (peer-reviewed)abstract
- BACKGROUND: Unplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined. OBJECTIVE: To estimate the risk of in-hospital mortality associated with unplanned admission to the ICU in patients aged 80 years and over. DESIGN, SETTING AND PARTICIPANTS: Retrospective review of an adult intensive care database. The setting was Liverpool Hospital, a large teaching hospital in Sydney, Australia, with a 28-bed ICU that has about 2000 admissions per year. We analysed data on very elderly patients (n = 1680), aged 80 years or more, admitted to the ICU between 1 January 1997 and 31 December 2007. MAIN OUTCOME MEASURES: Baseline risk factors for inhospital mortality. RESULTS: Mortality among patients with unplanned ICU admissions was 47%, compared with 25% in patients with planned admissions (adjusted rate ratio [RR], 1.92 [95% CI, 1.59-2.32]). An estimated 50% of the overall risk of inhospital death among very elderly patients was attributable to a combination of unplanned admission to the ICU, the presence of at least one comorbid condition, acute renal failure and respiratory failure requiring intubation. CONCLUSION: Unplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.
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| 8. |
- Grivans, Christina, 1963, et al.
(author)
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A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients.
- 2009
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In: Acta Anaesthesiol Scand. - : Wiley. - 1399-6576. ; 53:6, s. 710-6
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim was to describe current practices for drug administration through inhalation, endotracheal suctioning and lung recruitment maneuvers in mechanically ventilated patients in Scandinavian intensive care units (ICUs). METHODS: We invited 161 ICUs to participate in a web-based survey regarding (1) their routine standards and (2) current treatment of ventilated patients during the past 24 h. In order to characterize the patients, the lowest PaO(2) with the corresponding highest FiO(2), and the highest PaO(2) with the corresponding lowest FiO(2) during the 24-h study period were recorded. RESULTS: Eighty-seven ICUs answered and reported 186 patients. Positive end-expiratory pressure (PEEP) levels (cmH(2)O) were 5-9 in 65% and >10 in 31% of the patients. Forty percent of the patients had heated humidification and 50% received inhalation of drugs. Endotracheal suctioning was performed >7 times during the study period in 40% of the patients, of which 23% had closed suction systems. Twenty percent of the patients underwent recruitment maneuvers. The most common recruitment maneuver was to increase PEEP and gradually increase the inspiratory pressure. Twenty-six percent of the calculated PaO(2)/FiO(2) ratios varied >13 kPa for the same patient. CONCLUSION: Frequent use of drug administration through inhalation and endotracheal suctioning predispose to derecruitment of the lungs, possibly resulting in the large variations in PaO(2)/FiO(2) ratios observed during the 24-h study period. Recruitment maneuvers were performed only in one-fifth of the patients during the day of the survey.
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| 9. |
- Hillman, Ken, et al.
(author)
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Continuum of hospital care: the role of intensive care.
- 2010
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In: Current opinion in critical care. - 1531-7072. ; 16:5, s. 505-9
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Journal article (peer-reviewed)abstract
- This review outlines the way the specialty of intensive care has expanded over the last decade in response to the changing population of hospital patients, being older with more comorbidities and having more complex interventions. The previous disjointed professional and geographical silos, providing patient care, are being challenged and a more patient focussed continuum of care is replacing it.
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| 10. |
- Jonsson, Olof, 1941, et al.
(author)
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Enhanced post-ischaemic recovery in rabbit kidney after pretreatment with an indeno-indole compound and ascorbate monitored in vivo by 31P magnetic resonance spectroscopy.
- 2003
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In: Scandinavian Journal of Urology and Nephrology. - 0036-5599. ; 37:6, s. 450-455
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Journal article (peer-reviewed)abstract
- Objective: To investigate whether combined pretreatment with lipid- and water-soluble antioxidants gave better restoration of energy phosphates after ischaemia–reperfusion of rabbit kidneys than single pretreatment with a lipid-soluble antioxidant. Material and Methods: Thirteen New Zealand white rabbits were used for the study. Changes in energy phosphates were measured in vivo using volume-selective 31P magnetic resonance spectroscopy. The indeno–indole compound H290/51 was chosen as a lipid-soluble antioxidant and ascorbate as a water-soluble antioxidant. Results: The combined pretreatment led to significantly better restoration of the β-adenosine triphosphate:inorganic phosphate ratio after 60 min of ischaemia and 120 min of reperfusion compared with the single pretreatment. Analyses of blood pressure and blood gas changes showed that the beneficial effect of combined pretreatment was not caused by a better general condition of the animals in that group but by a direct effect on the kidneys. Conclusions: Combined pretreatment with lipid- and water-soluble antioxidants leads to better restoration of energy phosphates in rabbit kidneys subjected to ischaemia–reperfusion compared with single pretreatment with a lipid-soluble antioxidant.
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| 11. |
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| 12. |
- Laesser, Mats, 1969, et al.
(author)
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Candesartan improves survival following severe hypovolemia in pigs; a role for the angiotensin II type 2 receptor?
- 2005
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In: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 31:8, s. 1109-15
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the involvement of intestinal angiotensin II type 2 receptors in the outcome of acute severe hypovolemia as well as systemic and regional mesenteric hemodynamics and intestinal mucosal functions in anesthetized pigs. DESIGN AND SETTING: Prospective, interventional animal study in a university research laboratory. SUBJECTS: 53 landrace pigs, 28-35 kg. INTERVENTIONS: 30+30% or 20+20% hemorrhage of estimated total blood volume followed by retransfusion performed in untreated controls, in animals treated with the angiotensin II type 1 receptor blocker candesartan or with a combination of candesartan and the angiotensin II type 2 receptor blocker PD123319. MEASUREMENTS AND RESULTS: Following 30+30% hemorrhage the candesartan-treated animals attained a significantly higher survival rate than controls and animals treated with PD123319 in combination with candesartan. Less pronounced hemorrhage (20+20%) resulted in no mortality and functional variables were assessed. A significantly higher output of jejunal intraluminal nitric oxide occurred during hypovolemia in the candesartan treated group than in controls and animals that received PD123319 in combination with candesartan. Jejunal transmucosal potential difference was significantly better preserved after retransfusion in candesartan-treated animals than in controls. Expression of angiotensin II type 2 receptors in intestinal tissue was significantly higher in animals surviving the 30+30% hemorrhage than in nonsurvivors. CONCLUSIONS: Lethal circulatory failure is possibly influenced by use of angiotensin receptor ligands, and activation of intestinal angiotensin II type 2 receptors may play a significant role in improving the outcome of severe hypovolemia.
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| 13. |
- Laesser, Mats, 1969, et al.
(author)
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The angiotensin II receptor blocker candesartan improves survival and mesenteric perfusion in an acute porcine endotoxin model.
- 2004
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In: Acta anaesthesiologica Scandinavica. - 0001-5172. ; 48:2, s. 198-204
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Journal article (peer-reviewed)abstract
- BACKGROUND: Blockade of the angiotensin II type 1 (AT1) receptor has been demonstrated to ameliorate splanchnic hypoperfusion in acute experimental circulatory failure. This study focused on hemodynamic changes and survival in pigs treated with AT1 blockade prior to or during acute endotoxinemia. METHODS: Escherichia coli lipopolysaccharide endotoxin was infused in anesthetized and mechanically ventilated pigs. Systemic, renal, mesenteric and jejunal mucosal perfusion as well as systemic oxygen and acid-base balance were monitored. The selective AT1 receptor blocker candesartan was administered prior to as well as during endotoxinemia. Control animals received the saline vehicle. RESULTS: Pre-treatment with candesartan resulted in higher survival rate (83%, 10 out of 12 animals) compared with 50% (6 of 12) in control animals and 27% (3 of 11) in animals treated during endotoxinemia. Pre-treatment with candesartan resulted in higher cardiac output, mixed venous oxygen saturation, arterial standard base-excess, portal venous blood flow during endotoxin infusion compared with controls and animals treated during endotoxinemia. No adverse effects were found on neither systemic nor renal circulation. CONCLUSION: The favorable results of AT1 receptor blockade prior to endotoxinemia are lost when blockade is established during endotoxinemia demonstrating the importance of the renin-angiotensin system and its dynamic involvement in acute endotoxinemic shock.
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| 14. |
- Löwhagen Hendén, Pia, et al.
(author)
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Can Baroreflex Sensitivity and Heart Rate Variability Predict Late Neurological Outcome in Patients With Traumatic Brain Injury?
- 2014
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In: Journal of neurosurgical anesthesiology. - 1537-1921. ; 26:1, s. 50-59
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Journal article (peer-reviewed)abstract
- Previous studies have suggested that depressed heart rate variability (HRV) and baroreflex sensitivity (BRS) are associated with early mortality and morbidity in patients with acute brain injuries of various etiologies. The aim of the present study was to assess changes in HRV and BRS in isolated traumatic brain injury (TBI), with the hypothesis that measurement of autonomic nervous system dysfunction can provide prognostic information on late neurological outcome.
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| 15. |
- Nyberg, Annette, 1967, et al.
(author)
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Pulmonary net release of tissue-type plasminogen activator during porcine primary and secondary acute lung injury.
- 2004
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 48:7, s. 845-50
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Journal article (peer-reviewed)abstract
- BACKGROUND: Tissue-type plasminogen activator (tPA) is a key mediator of fibrinolysis. Matching of pulmonary perfusion and ventilation is a critical denominator of oxygenation in acute lung injury (ALI). This study investigates pulmonary venoarterial plasma tPA gradients in association with acute ALI induced by bronchoalveolar lavage (BAL) and endotoxinemia (ETX). METHODS: Twenty-one anaesthetized, ventilated pigs were allocated to control (CTRL, n=5), bronchoalveolar saline lavage (BAL, n=8) or infusion of Escherichia coli endotoxin (ETX, n=8). Total tPA was analyzed in plasma (ELISA calibrated for porcine tPA). The inflammatory response was assessed by TNFa levels (ELISA). All variables were assessed at baseline and 2 h following ALI. RESULTS: Bronchoalveolar lavage and ETX induced similar increases in pulmonary shunt whereas pulmonary vascular resistance was significantly more increased in ETX animals. Cardiac output remained stable in BAL animals but decreased in ETX animals. The pulmonary venoarterial tPA plasma gradient increased in ETX animals, yielding a positive pulmonary net flux of tPA, which was absent in BAL animals. TNFalpha levels increased in ETX, but not in BAL, animals. A significant correlation was observed between TNFalpha and tPA plasma levels in ETX animals. All variables remained unchanged in CTRL animals. CONCLUSION: Plasma changes of tPA levels support a pulmonary release of tPA in early experimental ALI induced by acute ETX but not lavage, and are related to the inflammatory response. Despite increased vascular fibrinolytic capacity in ETX animals, pulmonary dysfunction was not different from BAL animals. The results demonstrate the close relation between inflammation and coagulation in early ALI.
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| 16. |
- Nyberg, Annette, 1967, et al.
(author)
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Time- and dose-related regional fluxes of tissue-type plasminogen activator in anesthetized endotoxemic pigs.
- 2008
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 52:1, s. 57-64
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Acute endotoxinemia elicits an early fibrinolytic response. This study analyzes the effects of the dose and duration of endotoxin infusion on arterial levels of tissue-type plasminogen activator (tPA) and pulmonary, mesenteric and hepatic plasma tPA fluxes. METHODS: Pigs were randomized to receive an acute, high-dose (for 6 h, n=13, high ETX) or a prolonged, low-dose (for 18 h, n=18, low ETX) infusion of endotoxin or saline vehicle alone (for 18 h, n=14, control). All animals were fluid resuscitated to maintain a normodynamic circulation. Systemic and regional blood flows were measured and arterial, pulmonary arterial, portal and hepatic venous blood samples were analyzed to calculate regional net fluxes of tPA. Plasma tumor necrosis factor (TNF-alpha) levels were analyzed. RESULTS: Mesenteric tPA release and hepatic uptake increased maximally at 1.5 h in ETX groups related to dose. Maximal mesenteric tPA release [high ETX 612 (138-1185) microg/min/kg, low ETX 72 (32-94) microg/min/kg, median+/-interquartile range] and hepatic tPA uptake [high ETX -1549 (-1134 to -2194) microg/min/kg, low ETX -153 (-105 to -307) microg/min/kg] correlated to TNF-alpha levels. Regional tPA fluxes returned to baseline levels at 6 h in both ETX groups and also remained low during sustained low ETX. No changes were observed in control animals. CONCLUSIONS: Endotoxemia induces an early increase in mesenteric tPA release and hepatic tPA uptake related to the severity of endotoxemia. The time patterns of changes in mesenteric and hepatic tPA fluxes are similar in acute high-dose endotoxemia and sustained low-dose endotoxemia.
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| 17. |
- Odenstedt, Helena, 1968, et al.
(author)
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Acute hemodynamic changes during lung recruitment in lavage and endotoxin-induced ALI.
- 2005
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In: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 31:1, s. 112-20
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To assess acute cardiorespiratory effects of recruitment manoeuvres in experimental acute lung injury. DESIGN: Experimental study in animal models of acute lung injury. SETTING: Experimental laboratory at a University Medical Centre. ANIMALS: Ten pigs with bronchoalveolar lavage and eight pigs with endotoxin-induced ALI. INTERVENTIONS: Two kinds of recruitment manoeuvres during 1 min; a) vital capacity manoeuvres (ViCM) consisting in a sustained inflation at 30 cmH(2)O and 40 cmH(2)O; b) manoeuvres obtained during ongoing pressure-controlled ventilation (PCRM) with peak airway pressure 30 cmH(2)O, positive end-expiratory pressure (PEEP) 15 and peak airway pressure 40, PEEP 20. Recruitment manoeuvres were repeated after volume expansion (dextran 8 ml/kg). Oxygenation, mean arterial, and pulmonary artery pressures, aortic, mesenteric, and renal blood flow were monitored. MEASUREMENTS AND RESULTS: Lower pressure recruitment manoeuvres (ViCM30 and PCRM30/15) did not significantly improve oxygenation. With ViCM and PCRM at peak airway pressure 40 cmH(2)O, PaO(2) increased to similar levels in both lavage and endotoxin groups. Aortic blood flow was reduced from baseline during PCRM40/20 and ViCM40 by 57+/-3% and 61+/-6% in the lavage group and by 57+/-8% and 82+/-7% (P<0.05 vs PCRM40/20) in endotoxin group. The decrease in blood pressure was less pronounced. Prior volume expansion attenuated circulatory impairment. After cessation of recruitment hemodynamic parameters were restored within 3 min. CONCLUSION: Effective recruitment resulted in systemic hypotension, pulmonary hypertension, and decrease in aortic blood flow especially in endotoxinemic animals. Circulatory depression may be attenuated using recruitment manoeuvres during ongoing pressure-controlled ventilation and by prior volume expansion.
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| 18. |
- Odenstedt, Helena, 1968, et al.
(author)
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Slow moderate pressure recruitment maneuver minimizes negative circulatory and lung mechanic side effects: evaluation of recruitment maneuvers using electric impedance tomography.
- 2005
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In: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 31:12, s. 1706-14
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the efficacy of different lung recruitment maneuvers using electric impedance tomography. DESIGN AND SETTING: Experimental study in animal model of acute lung injury in an animal research laboratory. SUBJECTS: Fourteen pigs with saline lavage induced lung injury. INTERVENTIONS: Lung volume, regional ventilation distribution, gas exchange, and hemodynamics were monitored during three different recruitment procedures: (a) vital capacity maneuver to an inspiratory pressure of 40 cmH2O (ViCM), (b) pressure-controlled recruitment maneuver with peak pressure 40 and PEEP 20 cmH2O, both maneuvers repeated three times for 30 s (PCRM), and (c) a slow recruitment with PEEP elevation to 15 cmH2O with end inspiratory pauses for 7 s twice per minute over 15 min (SLRM). MEASUREMENTS AND RESULTS: Improvement in lung volume, compliance, and gas exchange were similar in all three procedures 15 min after recruitment. Ventilation in dorsal regions of the lungs increased by 60% as a result of increased regional compliance. During PCRM compliance decreased by 50% in the ventral region. Cardiac output decreased by 63+/-4% during ViCM, 44+/-2% during PCRM, and 21+/-3% during SLRM. CONCLUSIONS: In a lavage model of acute lung injury alveolar recruitment can be achieved with a slow lower pressure recruitment maneuver with less circulatory depression and negative lung mechanic side effects than with higher pressure recruitment maneuvers. With electric impedance tomography it was possible to monitor lung volume changes continuously.
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| 19. |
- Oltean, Mihai, 1976, et al.
(author)
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Laser-Doppler flowmetry in the monitoring of the human intestinal allograft: a preliminary report.
- 2006
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In: Transplantation proceedings. - : Elsevier BV. - 0041-1345. ; 38:6, s. 1723-5
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Journal article (peer-reviewed)abstract
- During acute rejection, graft endothelium becomes a prime target for recipient immune cells. Animal studies have shown reduced microvascular perfusion, probably due to increased endothelial-leukocyte interaction and endothelial impairment, leading to graft damage. Using laser-Doppler flowmetry (LDF), we correlated the microvascular blood flow in the intestinal mucosa of five patients receiving multivisceral grafts with clinical events and pathology results. Measurements (n = 75) were performed during the first 4 weeks posttransplantation by inserting the LDF flexible probe through the ileostomy for 25 to 30 cm. Forty-six of the 75 measurements were performed within 24 hours of endoscopy and biopsy. In uncomplicated cases, we recorded a gradual increase in mucosal perfusion during the first week posttransplantation that presumably reflected regeneration after reperfusion injury. Increased mucosal perfusion did not seem to correlate with rejection or other adverse clinical events. Sudden and sustained decreases in mucosal perfusion by 30% or more compared to the previous measurements were associated with septic episodes, rejection, or both. LDF revealed a good sensitivity in monitoring the intestinal microcirculation. It was able to indicate perfusion changes associated with acute rejection. The relatively low specificity of LDF may be compensated by the low invasivity, allowing frequent investigation. LDF may be an additional tool for routine monitoring of intestinal allografts.
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| 20. |
- Oltean, Mihai, 1976, et al.
(author)
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Monitoring of the intestinal mucosal perfusion using laser Doppler flowmetry after multivisceral transplantation
- 2005
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In: Transplantation proceedings. - 0041-1345. ; 37:8, s. 3323-4
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Journal article (peer-reviewed)abstract
- BACKGROUND: Graft endothelium constitutes a prime target during acute rejection. Infiltration of T cells, monocytes, and enhanced endothelial-leukocyte interactions result in microvascular impairment and altered perfusion. MATERIALS AND METHODS: We measured mucosal blood flow using a laser Doppler flowmeter in three patients undergoing multivisceral transplantation. Thirty-seven measurements were performed through the ileostomy over the first 4 weeks posttransplantation. Most measurements were performed within a 24-hour interval from endoscopy and biopsy. RESULTS: Mucosal perfusion increased throughout the first postoperative week and eventually stabilized around levels specific for each patient. Mucosal perfusion remained stable during graft pancreatitis, but decreased 35% to 55% from baseline (the average value of the previous measurements) during acute rejection and sepsis. During the first week posttransplantation there was a gradual increase in mucosal perfusion, which might reflect regeneration after reperfusion injury. Increased mucosal perfusion did not seem to correlate with rejection or other adverse clinical events. A sudden decrease in mucosal perfusion of 30% or more compared to the previous measurements was associated with septic episodes and/or rejection.
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| 21. |
- Sanghavi, R, et al.
(author)
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Systemic capillary leak syndrome associated with compartment syndrome and rhabdomyolysis.
- 2006
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In: Anaesthesia and intensive care. - 0310-057X. ; 34:3, s. 388-91
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Journal article (peer-reviewed)abstract
- Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by recurrent spontaneous episodes of hypovolaemic shock due to marked plasma shifts from the intravascular to the extravascular space. This presents as the characteristic triad of hypotension, haemoconcentration and hypoalbuminemia often with an associated monoclonal gammopathy. We describe a patient with SCLS who required aggressive fluid resuscitation and emergency fasciotomies for compartment syndrome with rhabdomyolysis. At presentation the patient was considered to have severe erythrocytosis and was therefore initially referred to a haematologist, which appears to be a frequent sequence of presentation for patients with SCLS. This patient also highlights the importance of muscle compartment pressure monitoring during volume resuscitation in patients with SCLS.
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| 22. |
- Skrifvars, M. B., et al.
(author)
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Monitoring and modifying brain oxygenation in patients at risk of hypoxic ischaemic brain injury after cardiac arrest
- 2021
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In: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 25:1
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Journal article (peer-reviewed)abstract
- This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901.
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| 23. |
- Snygg, Johan, 1963, et al.
(author)
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Fluid therapy in acute myocardial infarction: evaluation of predictors of volume responsiveness.
- 2009
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In: Acta Anaesthesiol Scand. - : Wiley. - 1399-6576. ; 53:1, s. 26-33
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Journal article (peer-reviewed)abstract
- BACKGROUND: Static vascular filling pressures suffer from poor predictive power in identifying the volume-responsive heart. The use of dynamic arterial pressure variables, including pulse pressure variation (PPV) has instead been suggested to guide volume therapy. The aim of the present study was to evaluate the performance of several clinically applicable haemodynamic parameters to predict volume responsiveness in a pig closed chest model of acute left ventricular myocardial infarction. METHODS: Fifteen anaesthetized, mechanically ventilated pigs were studied following acute left myocardial infarction by temporary coronary occlusion. Animals were instrumented to monitor central venous (CVP) and pulmonary artery occlusion (PAOP) pressures and arterial systolic variations (SPV) and PPV. Cardiac output (CO) was measured using the pulmonary artery catheter and by using the PiCCO monitor also giving stroke volume variation (SVV). Variations in the velocity time integral by pulsed-wave Doppler echocardiography were determined in the left (DeltaVTI(LV)) and right (DeltaVTI(RV)) ventricular outflow tracts. Consecutive boluses of 4 ml/kg hydroxyethyl starch were administered and volume responsiveness was defined as a 10% increase in CO. RESULTS: Receiver-operator characteristics (ROC) demonstrated the largest area under the curve for DeltaVTI(RV) [0.81 (0.70-0.93)] followed by PPV [0.76 (0.64-0.88)] [mean (and 95% CI)]. SPV, DeltaVTI(LV) and SVV did not change significantly during volume loading. CVP and PAOP increased but did not demonstrate significant ROC. CONCLUSION: PPV may be used to predict the response to volume administration in the setting of acute left ventricular myocardial infarction.
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| 24. |
- Spak, Emma, 1977, et al.
(author)
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Angiotensin II receptor expression following intestinal transplantation in mice.
- 2006
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In: The Journal of surgical research. - : Elsevier BV. - 0022-4804. ; 135:1, s. 144-9
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Journal article (peer-reviewed)abstract
- BACKGROUND: To further improve the success rate of intestinal transplantation there is a need to find early appearing indicators of rejection. The specific aim of this study was to compare Angiotensin (Ang) II type 1 receptor and Ang II type 2 receptor expression in relation to histological signs of rejection. METHODS: Mice of the C57BL6 strain with syngeneic intestinal grafts were compared to mice subjected to allogeneic intestinal transplantation with BalbC strain as donors. Local expression of Ang II type 1 and 2 receptor was evaluated using rt-PCR and Western blot and compared to histological picture in grafts and native intestine. RESULTS: The Ang II type 2 receptor protein expression was markedly up-regulated in the allogeneically transplanted graft from day 1 postoperatively. Histological signs of rejection were not seen until day 6. CONCLUSION: Intestinal allograft transplantation in mice is associated with a marked up-regulation of the Ang II type 2 receptor. However, the detailed role of the renin-angiotensin system in the immune rejection following intestinal transplantation remains to be clarified.
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| 25. |
- Söndergaard, Sören, 1951, et al.
(author)
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Central venous pressure: we need to bring clinical use into physiological context.
- 2015
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In: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 59:5, s. 552-60
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Research review (peer-reviewed)abstract
- The place of central venous pressure (CVP) measurement in acute care has been questioned during the past decade. We reviewed its physiological importance, utility and clinical use among anaesthetists and intensivists.
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