| 1. |
- Cristescu, S. M., et al.
(författare)
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Methods of NO detection in exhaled breath
- 2013
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Ingår i: Journal of Breath Research. - : IOP Publishing. - 1752-7155 .- 1752-7163. ; 7:1, s. 017104-
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Tidskriftsartikel (refereegranskat)abstract
- There is still an unexplored potential for exhaled nitric oxide (NO) in many clinical applications. This study presents an overview of the currently available methods for monitoring NO in exhaled breath and the use of the modelling of NO production and transport in the lung in clinical practice. Three technologies are described, namely chemiluminescence, electrochemical sensing and laser-based detection with their advantages and limitations. Comparisons are made in terms of sensitivity, time response, size, costs and suitability for clinical purposes. The importance of the flow rate for NO sampling is discussed from the perspective of the recent recommendations for standardized procedures for online and offline NO measurement. The measurement of NO at one flow rate, such as 50 ml s(-1), can neither determine the alveolar site/peripheral contribution nor quantify the difference in NO diffusion from the airways walls. The use of NO modelling (linear or non-linear approach) can solve this problem and provide useful information about the source of NO. This is of great value in diagnostic procedures of respiratory diseases and in treatment with anti-inflammatory drugs.
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| 2. |
- Högman, Marieann, et al.
(författare)
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A practical approach to the theoretical models to calculate NO parameters of the respiratory system
- 2014
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Ingår i: Journal of breath research. - : IOP Publishing. - 1752-7163 .- 1752-7155. ; 8:1, s. 016002-
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Tidskriftsartikel (refereegranskat)abstract
- Expired nitric oxide (NO) is used as a biomarker in different respiratory diseases. The recommended flow rate of 50 mL s⁻¹ (F(E)NO₀.₀₅) does not reveal from where in the lung NO production originated. Theoretical models of NO transfer from the respiratory system, linear or nonlinear approaches, have therefore been developed and applied. These models can estimate NO from distal lung (alveolar NO) and airways (bronchial flux). The aim of this study was to show the limitation in exhaled flow rate for the theoretical models of NO production in the respiratory system, linear and nonlinear models. Subjects (n = 32) exhaled at eight different flow rates between 10-350 mL s⁻¹ for the theoretical protocols. Additional subjects (n = 32) exhaled at tree flow rates (20, 100 and 350 mL s⁻¹) for the clinical protocol. When alveolar NO is calculated using high flow rates with the linear model, correction for axial back diffusion becomes negligible, -0.04 ppb and bronchial flux enhanced by 1.27. With Högman and Meriläinen algorithm (nonlinear model) the corrections factors can be understood to be embedded, and the flow rates to be used are ≤20, 100 and ≥350 mL s⁻¹. Applying these flow rates in a clinical setting any F(E)NO can be calculated necessitating fewer exhalations. Hence, measured F(E)NO₀.₀₅ 12.9 (7.2-18.7) ppb and calculated 12.9 (6.8-18.7) ppb. In conclusion, the only possibility to avoid inconsistencies between research groups is to use the measured NO values as such in modelling, and apply tight quality control to accuracies in both NO concentration and exhaled flow measurements.
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| 3. |
- Högman, Marieann, et al.
(författare)
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Added value with extended NO analysis in atopy and asthma
- 2011
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Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961 .- 1475-097X. ; 31:4, s. 294-299
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Assessments of the usefulness of exhaled nitric oxide (NO) in the treatment of asthma have given conflicting results. It is not always obvious if atopic status has been tested in these evaluations. OBJECTIVES: The aim of the study is to use extended NO analysis to characterize subjects from a random sample populations with focus on rhinitis and asthma. METHODS: Data were extracted from the European Community Respiratory Health Survey II. A subgroup from the Uppsala site that had had their NO measured at multiple flow rates was included (n = 284). The nonlinear model for NO parameters was used. Atopy was defined as having a titre against at least one of the tested allergens ≥0·35 kU l(-1) . Bronchial responsiveness was assessed by methacholine challenge. RESULTS: Subjects with non-atopic rhinitis or non-atopic asthma could not be separated from healthy subjects regarding NO parameters. There was a gradual increase with atopy in airway diffusion rate (D(aw) NO); healthy subject 8·0 (7·3, 8·8), healthy atopic 8·8 (6·7, 11·5), atopic rhinitis 10·6 (9·0, 12·4) and atopic asthma 11·2 (9·9, 28·3) ml s(-1) [geometrical mean (CI(95%) )]. There was a correlation between bronchial responsiveness and D(aw) NO in atopic rhinitis (r = -0·41, P<0·01), and bronchial responsiveness and airway wall content of NO (C(aw) NO) in atopic asthma (r = -0·56, P<0·001). CONCLUSION: It is of importance to characterize atopic status when evaluating the association between NO and asthma. Our results indicate that the use of extended NO analysis, with particular attention to D(aw) NO and C(aw) NO, may be useful in monitoring treatment for rhinitis and asthma.
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| 4. |
- Högman, Marieann
(författare)
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Extended NO analysis in health and disease
- 2012
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Ingår i: Journal of breath research. - : IOP Publishing. - 1752-7163 .- 1752-7155. ; 6:4, s. 047103-
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Tidskriftsartikel (refereegranskat)abstract
- Extended NO analysis is a promising tool in different diseases where NO metabolism is altered. One single exhalation cannot give insight to the NO production in the respiratory system; rather the use of multiple exhalation flows can give the alveolar levels (CANO), airway wall concentration (CawNO) and the diffusion rate of NO (DawNO). Increased values of CANO are shown in COPD, systemic sclerosis, hepatopulmonary syndrome and in severe asthma. In asthma the CawNO and DawNO are increased leading to an increase in bronchial NO flux (J'awNO). Low levels of J'awNO are seen in cystic fibrosis, primary ciliary dyskinesia and in smoking subjects. More studies are needed to evaluate the clinical usefulness of the extended NO analysis, similar to what has been done in systemic sclerosis where a cut-off value has been identified predicting pulmonary function deterioration.
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| 5. |
- Högman, Marieann, et al.
(författare)
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Guidance for a personal target value of F(E)NO in allergic asthma : case report and theoretical example
- 2013
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 118:1, s. 59-61
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Tidskriftsartikel (refereegranskat)abstract
- In clinically stable asthma the exhaled NO values (FENO) are generally higher than in control subjects. Therefore, reference values are of limited importance in clinical practice. This is demonstrated in this case report, but it is also shown that NO parameters from non-linear modelling do have a clinical value. A subject with asthma was treated with inhaled corticosteroids for 1 week. The non-linear NO model was used to measure the response to treatment. The NO parameters from subjects with atopic rhinitis and asthma were fed into a computer program to generate theoretical FENO50 values, i.e. target values. There was a dramatic decrease in FENO50 due to treatment, from 82 to 34 ppb, but it remained higher than in healthy controls. This is due to the elevated diffusion rate of NO, unchanged by treatment. When the NO parameters are known, a personal best value of FENO50 (fractional concentration of exhaled NO in the gas phase, 50 mL/s) can be calculated, which can be the target value when only FENO50 can be monitored. In conclusion, reference values for NO parameters are shown to be clinically useful. It is essential that every patient receives his/her target value of FENO50, when only a single NO measurement is available. In our opinion, this is the reason why there are few successful studies of trying to target the NO value with inhaled corticosteroids.
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| 6. |
- Högman, Marieann, et al.
(författare)
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Guidance for a personal target value of FeNO in allergic asthma : Case report and theoretical example
- 2013
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 118:1, s. 59-61
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Tidskriftsartikel (refereegranskat)abstract
- In clinically stable asthma the exhaled NO values (FENO) are generally higher than in control subjects. Therefore, reference values are of limited importance in clinical practice. This is demonstrated in this case report, but it is also shown that NO parameters from non-linear modelling do have a clinical value. A subject with asthma was treated with inhaled corticosteroids for 1 week. The non-linear NO model was used to measure the response to treatment. The NO parameters from subjects with atopic rhinitis and asthma were fed into a computer program to generate theoretical FENO0.05 values, i.e. target values. There was a dramatic decrease in FENO0.05 due to treatment, from 82 to 34 ppb, but it remained higher than in healthy controls. This is due to the elevated diffusion rate of NO, unchanged by treatment. When the NO parameters are known, a personal best value of FENO0.05 (fractional concentration of exhaled NO in the gas phase, 0.05 L/s) can be calculated, which can be the target value when only FENO0.05 can be monitored. In conclusion, reference values for NO parameters are shown to be clinically useful. It is essential that every patient receives his/her target value of FENO0.05, when only a single NO measurement is available. In our opinion, this is the reason why there are few successful studies of trying to target the NO value with inhaled corticosteroids.
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| 7. |
- Knudsen, Kati, et al.
(författare)
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A nationwide postal questionnaire survey : the presence of airway guidelines in anaesthesia department in Sweden
- 2014
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Ingår i: BMC Anesthesiology. - London : BioMed Central. - 1471-2253 .- 1471-2253. ; 14:25
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, airway guidelines aimed toward improving patient safety have been recommended by the Swedish Society of Anaesthesia and Intensive Care Medicine. Adherence to evidence-based airway guidelines is known to be generally poor in Sweden. The aim of this study was to determine whether airway guidelines are present in Swedish anaesthesia departments.Methods: A nationwide postal questionnaire inquiring about the presence of airway guidelines was sent out to directors of Swedish anaesthesia departments (n = 74). The structured questionnaire was based on a review of the Swedish Society of Anaesthesia and Intensive Care voluntary recommendations of guidelines for airway management. Mean, standard deviation, minimum/maximum, percentage (%) and number of general anaesthesia performed per year as frequency (n), were used to describe, each hospital type (university, county, private). For comparison between hospitals type and available written airway guidelines were cross tabulation used and analysed using Pearson’s Chi-Square tests. A p- value of less than 0 .05 was judged significant.Results: In total 68 directors who were responsible for the anaesthesia departments returned the questionnaire, which give a response rate of 92% (n 68 of 74). The presence of guidelines showing an airway algorithm was reported by 68% of the departments; 52% reported having a written patient information card in case of a difficult airway and guidelines for difficult airways, respectively; 43% reported the presence of guidelines for preoperative assessment; 31% had guidelines for Rapid Sequence Intubation; 26% reported criteria for performing an awake intubation; and 21% reported guidelines for awake fibre-optic intubation. A prescription for the registered nurse anaesthetist for performing tracheal intubation was reported by 24%. The most frequently pre-printed preoperative elements in the anaesthesiarecord form were dental status and head and neck mobility.Conclusions: Despite recommendations from the national anaesthesia society, the presence of airway guidelines in Swedish anaesthesia departments is low. From the perspective of safety for both patients and the anaesthesia staff, airway management guidelines should be considered a higher priority
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| 8. |
- Knudsen, Kati, et al.
(författare)
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The best method to predict easy intubation : a quasi-experimental pilot study
- 2014
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1089-9472 .- 1532-8473. ; 29:4, s. 292-297
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To facilitate evaluation of the airway before endotracheal intubation, different scores have been developed, mainly to predict difficult airways. However, in anesthesia clinical practice in Sweden, scores would be more useful if they could also predict an easy airway, so that the correct category of anesthesia personnel can be allocated. Therefore, we evaluated whether scoring systems commonly used to predict difficult airways could also predict easy endotracheal intubation.DESIGN: This prospective observational study included patients who were scheduled for general anesthesia and required endotracheal intubation.METHODS: Airways were evaluated preoperatively by two independent variables, namely Mallampati classification and thyromental distance. After anesthesia induction, the Cormack and Lehane grade was assessed.FINDING: Mallampati scores yielded the highest specificity in predicting easy intubation, and Cormack and Lehane grades yielded the highest positive predictive value for predicting easy intubation.CONCLUSIONS: Mallampati classification is an appropriate screening test for predicting easy intubation.
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| 9. |
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| 10. |
- Lindberg, Maria, et al.
(författare)
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Attitudes toward patients with multidrug-resistant bacteria : scale development and psychometric evaluation
- 2011
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Ingår i: Journal of Infection Prevention. - : SAGE Publications. - 1757-1782 .- 1757-1774. ; 12:5, s. 196-203
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for validated assessment tools for measuring attitudes towards patients with multid-rug-resistant bacteria. Such an assessment tool was developed and psychometrically evaluated in the present study. A literature review and discussions with experts and key informants were used to develop the questionnaire. To ensure item adequacy and interpretability, face validity and pre-tests were performed. Item validity, content validity and internal consistency reliability were evaluated in a non-random sample of 329 hemodialysis nurses. The psychometric properties were satisfactory, indicating good item validity. The content validity revealed three appropriate factors with good internal consistency reliability. The haemodialysis nurses′ knowledge about multidrug-resistant bacteria was not sufficient, and their intentional behaviour was unsatisfactory with respect to infection control precautions. The multidrug-resistant bacteria Attitude Questionnaire would be a valuable tool, in nursing practice and nursing education, in promoting quality improvements in patient safety with regard to healthcare associated infections.
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