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- Almgren, Birgitta, et al.
(author)
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Side effects of endotracheal suction in pressure and volume controlled ventilation
- 2004
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In: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 125:3, s. 1077-1080
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVES:To investigate the effects of endotracheal suction in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) with an open suction system (OSS) or a closed suction system (CSS).DESIGN:Randomized comparison.SETTING:Animal research laboratory.PATIENTS:Twelve healthy anesthetized pigs.INTERVENTIONS:The effects of endotracheal suction during VCV and PCV with tidal volume (VT) of 14 mL/kg were compared. A 60-mm inner-diameter endotracheal tube was used. Ten-second suction was performed using OSS and CSS with 12F and 14F catheters connected to - 14 kPa vacuum.MEASUREMENTS AND RESULTS:Thirty minutes after suction in PCV, VT was still decreased by 27% (p < 0.001), compliance (Crs) by 28% (p < 0.001), and PaO(2) by 26% (p < 0.001); PaCO(2) was increased by 42% (p < 0.0001) and venous admixture by 158% (p = 0.003). Suction in VCV affected only Crs (decreased by 23%, p < 0.001) and plateau pressure (increased by 24%, p < 0.001). The initial impairment of gas exchange following suction in VCV was no longer statistically significant after 30 min.CONCLUSIONS:In conclusion, endotracheal suction causes lung collapse leading to impaired gas exchange, an effect that is more severe and persistent in PCV than in VCV.
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- Johansson, Gunnar, et al.
(author)
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Asthma treatment preference study : a conjoint analysis of preferred drug treatments
- 2004
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In: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 125:3, s. 916-923
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Assessment of patient preferences for attributes of asthma treatments. METHODS: Two hundred ninety-eight patients (age range, 18 to 60 years) from 15 centers in Sweden completed a questionnaire concerning their asthma, and ranked 18 alternative treatments using conjoint analysis. Patients were receiving treatment with either inhaled corticosteroids (ICS) and short-acting bronchodilator (n = 123) or ICS and long-acting bronchodilator (separate inhalers, n = 87; combination inhaler, n = 88). Attributes analyzed were maintenance treatment, additional reliever, time to onset and duration of reliever, number of symptom-free days (SFDs) per month, and out-of-pocket cost per month. RESULTS: Conjoint analysis showed that the most important aspect of treatment was SFD. Forty percent of the patients had CONCLUSION: SFDs were the most important attribute in asthma treatment. Patients were willing to pay for a switch to their preferred treatment. The most favored treatments were a reliever therapy that is both rapid and long acting and a combination inhaler for both maintenance and as-needed use.
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- Larsson, Matz L., et al.
(author)
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Environmental tobacco smoke exposure during childhood is associated with increased prevalence of asthma in adults
- 2001
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In: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 120:3, s. 711-717
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To examine if exposure to environmental tobacco smoke (ETS) during childhood has an impact on asthma prevalence in adults, and to identify the amount of nuisance from ETS and other lower airway irritants (LAWIs) in a city population. DESIGN: A postal survey. SETTING: The municipality of Orebro, Sweden. PARTICIPANTS: A total of 8,008 randomly selected inhabitants aged 15 to 69 years. MEASUREMENTS: Exposures, airway symptoms, and respiratory history were assessed using a questionnaire. RESULTS: The response rate was 84%. In never-smokers with childhood ETS exposure, the prevalence of physician-diagnosed asthma was 7.6% vs 5.9% in nonexposed subjects (p = 0.036). In never-smokers without a family history of asthma, the prevalence of physician-diagnosed asthma in subjects reporting childhood ETS exposure was 6.8% vs 3.8% in nonexposed subjects (p < 0.001). Subjects with childhood ETS exposure were more likely to start smoking in adulthood. The prevalence of ever-smokers was 54.5% vs 33.8% (p < 0.0001) in nonexposed subjects. ETS was the most commonly reported LAWI in the total sample (21%), followed by exercise in cold air (20%), dust (19%), exercise (16%), perfume (15%), cold air (12%), pollen (10%), and pets (8%). All LAWIs were more frequently reported by women. CONCLUSIONS: Childhood exposure to ETS is associated with an increased prevalence of asthma among adult never-smokers, especially in nonatopic subjects. Children exposed to ETS are also more likely to become smokers. ETS is as a major LAWI.
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- Lindström, Mai, et al.
(author)
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Smoking, respiratory symptoms, and diseases : a comparative study between northern Sweden and northern Finland: report from the FinEsS study
- 2001
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In: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 119:3, s. 852-861
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Journal article (peer-reviewed)abstract
- AB - STUDY OBJECTIVES: The influences of different smoking categories on the prevalence of respiratory symptoms, asthma, and chronic bronchitis have been examined in the most northern province of Sweden, Norrbotten, and in Lapland, Finland. The two areas have similar geographic and demographic conditions. METHODS AND STUDY POPULATION: The study is a part of the FinEsS studies, which are epidemiologic respiratory surveys in progress in Sweden, Finland, and Estonia. A random sample of 20- to 69-years-olds were invited to answer a postal questionnaire about respiratory symptoms, smoking habits, and occupation. In Norrbotten, 8,333 subjects were invited and 7,104 responded (85%). In Lapland, 8,005 were invited and 6,633 responded (83%). RESULTS: The participation by age and sex was similar in both countries. The prevalence of smokers in Lapland was 32% vs 26% in Norrbotten. Significantly more women than men in Norrbotten were smokers, while the opposite was true for Lapland. Sputum production was the most prevalent symptom in both areas, 25% in Lapland vs 19% in Norrbotten. The prevalence of chronic productive cough was 11% in Lapland and 7% in Norrbotten. Bronchitic symptoms were more prevalent in Lapland among both smokers and nonsmokers. A positive family history of chronic obstructive airway disease together with increased number of consumed cigarettes showed an additive effect for both chronic productive cough and wheezing. The odds ratio (OR) for wheezing during the last 12 months was 3.8 for subjects without a family history of obstructive airway disease who consumed > 14 cigarettes per day compared with nonsmokers, but if the subjects had a family history of obstructive airway disease, the risk for wheezing increased to OR 8.4. CONCLUSION: Bronchitic symptoms were more common in Finland. The difference remained also after correction for demographic variables including smoking habits, age and socioeconomic group, and family history of obstructive airway disease. Identical methods, sample composition, and the high participation rate contribute to the validity of the results. Air pollution, including environmental tobacco smoke, may contribute to the difference. To explain the difference, further analysis and investigations of social and environmental factors as well as genetic factors are needed.
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- Lubenow, Norbert, et al.
(author)
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Heparin-induced thrombocytopenia : temporal pattern of thrombocytopenia in relation to initial use or reexposure to heparin.
- 2002
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In: Chest. - 0012-3692 .- 1931-3543. ; 122:1, s. 37-42
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVES: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction associated with a decrease of platelet counts that usually begins after at least 5 days of heparin treatment. Uncertainty exists about the risk of early onset of HIT (ie, < 5 days) in relation to previous heparin exposure. We therefore analyzed the temporal pattern of thrombocytopenia in patients with laboratory-confirmed HIT to assess whether patients with previous heparin exposure have an increased risk of early onset of HIT. DESIGN: Platelet count patterns in patients with a laboratory-confirmed diagnosis of HIT were examined in a retrospective chart review of a clinical study database. The onset of thrombocytopenia < 100 x 10(9)/L associated with the current heparin treatment (mainly unfractionated heparin) was analyzed using nonparametric maximum likelihood estimation. RESULTS: A total of 119 patients with 125 treatment episodes were assessed: HIT developed in 79 patients during initial exposure to heparin, and in 46 patients during reexposure. Early onset (< 5 days) of thrombocytopenia was associated with very recent heparin exposure. Patients reexposed to heparin within 3 months had an earlier onset of thrombocytopenia as compared to patients reexposed to heparin after 3 months (4.9 +/- 4.4 days vs 11.5 +/- 5.5 days [mean +/- SD], p = 0.001). There was no difference between onset on thrombocytopenia < 100 x 10(9)/L in patients reexposed to heparin within 3 to 12 months and after 1 year (9.7 +/- 6.4 days vs 12.3 +/- 5.2 days, p = 0.41). Whether platelet counts were obtained daily or less regularly did not affect the analysis. CONCLUSION: Early onset of thrombocytopenia in HIT is associated with recent heparin treatment (< 3 months). In contrast, for patients who did not receive heparin within the previous 3 months, HIT is an unlikely explanation for thrombocytopenia that occurs within the first 5 days.
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