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Bak, Zoltan
Publications (10 of 16) Show all publications
Steinvall, I., Fredrikson, M., Bak, Z. & Sjöberg, F. (2012). Incidence of early burn-induced effects on liver functionas reflected by the plasma disappearance rate of indocyanine green: a prospective descriptive cohort study. Burns, 38(2), 214-224
Open this publication in new window or tab >>Incidence of early burn-induced effects on liver functionas reflected by the plasma disappearance rate of indocyanine green: a prospective descriptive cohort study
2012 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 38, no 2, p. 214-224Article in journal (Refereed) Published
Abstract [en]

Organ dysfunction and failure are important for burned patients as they increase morbidity and mortality. Recent evidence has suggested that organ injuries are occurring earlier after burns, and are more common, than previously thought. In this study we have assessed the extent to which liver function, assessed by the plasma disappearance rate of indocyanine green (PDRICG), is affected in patients with severe burns. This is a prospective, descriptive exploratory study at a national burn centre. Consecutive adult patients with a total burned body surface area (TBSA%) of 20% or more, were examined prospectively by dynamic (PDRICG) and static liver function tests (plasma: bilirubin concentration, prothrombin complex, and alanine aminotransferase and alkaline phosphatase activities). Early liver dysfunction was common, as assessed by both dynamic (7 of 17) and static liver function tests (6-17 of 17). A regression model showed that changes in PDRICG were associated with age, TBSA%, plasma bilirubin concentration, plasma C-reactive protein concentration, and cardiac index. Persistent and advanced hepatic dysfunction was associated with mortality. The PDRICG seems to give a comprehensive assessment of liver function after major burns. Hepatic dysfunction seems to be as common as dysfunction in other organs. We interpret the recorded effects on liver function as part of a multiple organ dysfunction syndrome, primarily induced by the burn itself. However, this needs to be further investigated.

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
Burns, organ dysfunction, hepatic dysfunction, plasma disappearance rate of indocyanine green, age, cardiac index, sepsis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70059 (URN)10.1016/j.burns.2011.08.017 (DOI)000301621500010 ()
Note

On the day of the defence date the status of this article was "Manuscript".

Funding agencies|Department of Hand and Plastic Surgery, Linkoping University Hospital||PULSION Medical Systems AG, Munich, Germany||

Available from: 2011-08-17 Created: 2011-08-17 Last updated: 2017-12-08Bibliographically approved
Sjöberg, F., Iredahl, F., Larsen, R., Samuelsson, A., Thorfinn, J., Bak, Z., . . . Rousseau, A. (2011). Data visar att hyperbar syrgasbehandling kan vara skadlig. Läkartidningen, 108(32-33), 1506-1506
Open this publication in new window or tab >>Data visar att hyperbar syrgasbehandling kan vara skadlig
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2011 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 32-33, p. 1506-1506Article, review/survey (Other (popular science, discussion, etc.)) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75951 (URN)
Available from: 2012-03-19 Created: 2012-03-19 Last updated: 2017-12-07
Sjöberg, F., Larsen, R., Bak, Z., Samuelsson, A., Iredahl, F., Thorfinn, J., . . . Rousseau, A. (2011). Hyperbar syrgasbehandling kan vara skadlig vid kolmonoxidförgiftning. Läkartidningen, 108(32-33), 1506
Open this publication in new window or tab >>Hyperbar syrgasbehandling kan vara skadlig vid kolmonoxidförgiftning
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2011 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 32-33, p. 1506-Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75561 (URN)21922948 (PubMedID)
Available from: 2012-03-07 Created: 2012-03-07 Last updated: 2017-12-07
Steinvall, I., Fredrikson, M., Bak, Z. & Sjöberg, F. (2011). Mortality After Thermal Injury: No Sex-Related Difference. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 70(4), 959-964
Open this publication in new window or tab >>Mortality After Thermal Injury: No Sex-Related Difference
2011 (English)In: JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, ISSN 0022-5282, Vol. 70, no 4, p. 959-964Article in journal (Refereed) Published
Abstract [en]

Background: Young women have been reported to be more likely to survive than men after severe trauma. Girls also have less inflammation and hypermetabolism after major burns. Yet burned women have been found to have a twofold greater risk of death than men. Our aim was to find out if there is a sex-related difference in mortality after thermal injury, particularly in the age group between 16 years and 49 years, when hormonal differences would be most influential. Methods: All patients admitted to the Linkoping University Hospital Burn Unit with thermal injuries during the years 1993-2008 were included and the variables percentage burned total body surface area (TBSA%), age, type of burn, mechanical ventilation, and year were included in a multiple regression (Poisson log) model. Results: Of 1,119 patients with thermal injury, 792 (71%) were men. Crude mortality was 5% among men, and 8% among women (p = 0.04). After adjustment for age and TBSA%, there was no correlation between mortality and sex, in any age group. Eight men and four women died in the group of young adults (16-49 years) in which TBSA% correlated with mortality (p andlt; 0.01) but age did not. Mortality was 14% (32 of 221) among the men and 23% (23 of 102) of women in the group of older adults (50 years and older), and both age and TBSA% correlated with mortality (p andlt; 0.001). Conclusions: There is no relevant sex-related difference in survival after thermal injury. The conclusion is, however, tempered by the few deaths, particularly among younger adults.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS and WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA, 2011
Keywords
Burns, Outcome, Dimorphism, Age, Total body surface area
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67966 (URN)10.1097/TA.0b013e3181e59dbe (DOI)000289558700039 ()
Available from: 2011-05-04 Created: 2011-05-04 Last updated: 2012-03-25
Nilsson, A., Steinvall, I., Bak, Z. & Sjöberg, F. (2010). Letter: Patient controlled sedation using a standard protocol for dressing changes in burns: Patients preference, procedural details and a preliminary safety evaluation. Are studies always adequately powered and analyzed? Response [Letter to the editor]. Burns, 36(6), 948-950
Open this publication in new window or tab >>Letter: Patient controlled sedation using a standard protocol for dressing changes in burns: Patients preference, procedural details and a preliminary safety evaluation. Are studies always adequately powered and analyzed? Response
2010 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 36, no 6, p. 948-950Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Elsevier Science B.V., Amsterdam., 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-59267 (URN)10.1016/j.burns.2009.06.197 (DOI)000281182100037 ()
Available from: 2010-09-10 Created: 2010-09-10 Last updated: 2017-12-12Bibliographically approved
Bak, Z., Sjöberg, F., Eriksson, O., Steinvall, I. & Janerot Sjöberg, B. (2009). Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula. Journal of Trauma, 66(2), 329-336
Open this publication in new window or tab >>Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula
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2009 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 66, no 2, p. 329-336Article in journal (Refereed) Published
Abstract [en]

Background: The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints; for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly.

Methods: Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body sur-face area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints.

Results: Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung intrathoracal blood volume ratio was increased 12 hours after the burn.

Conclusions: Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment.

Keywords
Cardiovascular coupling, Echocardiography, Hemodynamic monitoring, Fractional area change, Global end-diastolic volume
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17146 (URN)10.1097/TA.0b013e318165c822 (DOI)
Available from: 2009-03-07 Created: 2009-03-07 Last updated: 2017-12-13
Steinvall, I., Bak, Z. & Sjöberg, F. (2008). Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study. Critical Care, 12(R124)
Open this publication in new window or tab >>Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study
2008 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 12, no R124Article in journal (Refereed) Published
Abstract [en]

Introduction: The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors ( age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis.

Method: We performed an explorative cohort study on patients with a TBSA% (percentage burned of total body surface area) of 20% or more who were admitted to a national burn centre. Acute kidney injury was classified according to the international consensus classification of RIFLE ( Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Prospectively collected clinical and laboratory data were used for assessing organ dysfunction, systemic inflammatory response, and sepsis.

Results: The incidence of acute kidney injury among major burns was 0.11 per 100,000 people per year. Of 127 patients, 31 (24%) developed acute kidney injury (12% Risk, 8% Injury, and 5% Failure). Mean age was 40.6 years (95% confidence interval [CI] 36.7 to 44.5), TBSA% was 38.6% (95% CI 35.5% to 41.6%), and 25% were women. Mortality was 14% and increased with increasing RIFLE class (7% normal, 13% Risk, 40% Injury, and 83% Failure). Renal dysfunction occurred within 7 days in 55% of the patients and recovered among all survivors. Age, TBSA%, and extent of full thickness burns were higher among the patients who developed acute kidney injury. Pulmonary dysfunction and systemic inflammatory response syndrome were present in all of the patients with acute kidney injury and developed before the acute kidney injury. Sepsis was a possible aggravating factor in acute kidney injury in 48%. Extensive deep burns (25% or more full thickness burn) increased the risk for developing acute kidney injury early (risk ratio 2.25).

Conclusions: Acute kidney injury is common, develops soon after the burn, and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated with mortality.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16218 (URN)10.1186/cc7032 (DOI)
Available from: 2009-02-27 Created: 2009-01-09 Last updated: 2017-12-14Bibliographically approved
Steinvall, I., Bak, Z. & Sjöberg, F. (2008). Acute respiratory distress syndrome is as important as inhalation injury for the development of respiratory dysfunction in major burns. Burns, 34(4), 441-451
Open this publication in new window or tab >>Acute respiratory distress syndrome is as important as inhalation injury for the development of respiratory dysfunction in major burns
2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 4, p. 441-451Article in journal (Refereed) Published
Abstract [en]

Respiratory dysfunction is common after major burns. The pathogenesis is, however, still under debate. The aim was to classify and examine underlying reasons for respiratory dysfunction after major burns. Consecutive adult patients (n = 16) with a total burned body surface area of 20% or more who required mechanical ventilation were assessed for acute respiratory distress syndrome (ARDS), inhalation injury, sepsis, ventilator-associated pneumonia (VAP), ventilator-induced lung injury (VILI), using conventional criteria, together with measurements of cardiovascular variables and viscoelastic properties of the lung including extravascular lung water.

Nine patients developed ARDS within 6 days of injury. ARDS was characterized by a large reduction in the PEEP-adjusted PaO2:FiO2 ratio, pulmonary compliance, and increased extra vascular lung water together with increased renal dysfunction rates. Seven patients fulfilled the criteria for inhalation injury. They also had decreased PaO2:FiO2 ratios. There was an increase in extra vascular lung water and a decrease in compliance measures though not to the same extent as in the ARDS group. White blood cell counts dropped from (mean) 21.4 x 10exp9 /l (95% CI 15.3-27.5) in day 1 to 4.3 x 10exp9 /l (2.2-6.5) on day 3, and lower values tended to correlate with the development of ARDS. Sepsis occurred before onset of ARDS in only three cases. One patient fulfilled the criteria for VAP, but none was thought to have VILI.

We found that respiratory dysfunction after burns is multifactorial, and ARDS and inhalation injury are most important. The early onset of ARDS, together with the changes in white blood cell count and organ dysfunction, favours a syndrome in which respiratory distress is induced by an inflammatory process mediated by the effect of the burn rather than being secondary to sepsis. The power of these conclusions is, however, hampered by the small number of patients in this study.    

Keywords
Burns, Inflammation, Leukocytes, Organ dysfunction, Permeability, Viscoelastic properties
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43096 (URN)10.1016/j.burns.2007.10.007 (DOI)71559 (Local ID)71559 (Archive number)71559 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Bak, Z., Sjöberg, F., Eriksson, O., Steinvall, I. & Janerot Sjöberg, B. (2008). Cardiac dysfunction after burns. Burns, 34(5), 603-609
Open this publication in new window or tab >>Cardiac dysfunction after burns
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2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 5, p. 603-609Article in journal (Refereed) Published
Abstract [en]

Objectives

Using transoesophageal echocardiography (TEE) we investigated the occurrence, and the association of possible abnormalities of motion of the regional wall of the heart (WMA) or diastolic dysfunction with raised troponin concentrations, or both during fluid resuscitation in patients with severe burns.

Patients and methods

Ten consecutive adults (aged 36–89 years, two women) with burns exceeding 20% total burned body surface area who needed mechanical ventilation were studied. Their mean Baux index was 92.7, and they were resuscitated according to the Parkland formula. Thirty series of TEE examinations and simultaneous laboratory tests for myocyte damage were done 12, 24, and 36 h after the burn.

Results

Half (n = 5) the patients had varying grades of leakage of the marker that correlated with changeable WMA at 12, 24 and 36 h after the burn (p ≤ 0.001, 0.044 and 0.02, respectively). No patient had WMA and normal concentrations of biomarkers or vice versa. The mitral deceleration time was short, but left ventricular filling velocity increased together with stroke volume.

Conclusion

Acute myocardial damage recorded by both echocardiography and leakage of troponin was common, and there was a close correlation between them. This is true also when global systolic function is not deteriorated. The mitral flow Doppler pattern suggested restrictive left ventricular diastolic function.

Keywords
Diastolic and regional systolic dysfunction; Echocardiography; Myocardial injury; Fluid resuscitation in burns; Myocardial infarction; Troponin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12901 (URN)10.1016/j.burns.2007.11.013 (DOI)
Available from: 2008-01-28 Created: 2008-01-28 Last updated: 2017-12-13
Nilsson, A., Steinvall, I., Bak, Z. & Sjöberg, F. (2008). Patient controlled sedation using a standard protocol for dressing changes in burns: Patients' preference, procedural details and a preliminary safety evaluation. Burns, 34(7), 929-934
Open this publication in new window or tab >>Patient controlled sedation using a standard protocol for dressing changes in burns: Patients' preference, procedural details and a preliminary safety evaluation
2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 7, p. 929-934Article in journal (Refereed) Published
Abstract [en]

Background: Patient controlled sedation (PCS) enables patients to titrate doses of drugs by themselves during different procedures involving pain or discomfort. Methods: We studied it in a prospective crossover design using a fixed protocol without lockout time to examine it as an alternative method of sedation for changing dressings in burned patients. Eleven patients with >10% total burn surface area (TBSA) had their dressings changed, starting with sedation by an anaesthetist (ACS). The second dressing change was done with PCS (propofol/alfentanil) and the third time the patients had to choose ACS or PCS. During the procedures, data on cardiopulmonary variables, sedation (bispectral index), pain intensity (VAS), procedural details, doses of drugs, and patients' preferences were collected to compare the two sedation techniques. Results: The study data indicated that wound care in burned patients is feasible with a standardized PCS protocol. The patients preferred PCS to ACS on the basis of self-control, and because they had less discomfort during the recovery period. Wound care was also considered adequate by the staff during PCS. No respiratory (respiratory rate/transcutaneous PCO2) or cardiovascular (heart rate/blood pressure) adverse events were recorded at any time during any of the PCS procedures. The doses of propofol and alfentanil and BIS index decrease were less during PCS than ACS. Procedural pain was higher during PCS but lower after the procedure. Conclusion: We suggest that PCS using a standard protocol is an interesting alternative to anaesthetist-provided sedation during dressing changes. It seems effective, saves resources, is safe, and at same time is preferred by the patients. The strength of these conclusions is, however, hampered by the small size of this investigation and therefore further studies are warranted. © 2008 Elsevier Ltd and ISBI.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43402 (URN)10.1016/j.burns.2008.04.002 (DOI)73753 (Local ID)73753 (Archive number)73753 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
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