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Waldréus, N., Hahn, R. G., Lyngå, P., van der Wal, M. H., Hägglund, E. & Jaarsma, T. (2016). Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.. Journal of Cardiovascular Nursing, 31(5), E17-E24
Open this publication in new window or tab >>Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.
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2016 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 5, p. E17-E24Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Thirst can be aggravated in patients with heart failure (HF), and optimization of HF medication can have positive impact on thirst.

OBJECTIVES: The aims of this study were to describe changes in thirst intensity and to determine factors associated with high thirst intensity during optimization of HF medication.

METHODS AND RESULTS: Patients with HF (N = 66) who were referred to an HF clinic for up-titration of HF medication were included. Data were collected during the first visit to the clinic and at the end of the treatment program. Data were dichotomized by the median visual analog scale score for thirst, dividing patients into 2 groups: low thirst intensity (0-20 mm) and high thirst intensity (>20 mm on a visual analog scale of 0-100 mm). In total, 67% of the patients reported a higher thirst intensity after the HF up-titration program. There was no difference in thirst intensity between the patients who reached target doses and those who did not. Plasma urea level (odds ratio, 1.33; 95% confidence interval, 1.07-1.65) and fluid restriction (odds ratio, 6.25; 95% confidence interval, 1.90-20.5) were independently associated with high thirst intensity in patients with HF.

CONCLUSIONS: Thirst intensity increased in two-thirds of the patients during a time period of optimization of HF medication. Fluid restriction and plasma urea levels were associated with high thirst intensity.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-125914 (URN)10.1097/JCN.0000000000000319 (DOI)000382251400003 ()26696035 (PubMedID)
Note

Funding agencies: Mats Klebergs Stiftelse; Lindhes Advokatbyra

Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-05-03Bibliographically approved
Hahn, R., Nyberg Isacson, M., Fagerstrom, T., Rosvall, J. & Nyman, C. R. (2016). Isotonic saline in elderly men: an open-labelled controlled infusion study of electrolyte balance, urine flow and kidney function. Anaesthesia, 71(2), 155-162
Open this publication in new window or tab >>Isotonic saline in elderly men: an open-labelled controlled infusion study of electrolyte balance, urine flow and kidney function
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2016 (English)In: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 71, no 2, p. 155-162Article in journal (Refereed) Published
Abstract [en]

Isotonic saline is a widely-used infusion fluid, although the associated chloride load may cause metabolic acidosis and impair kidney function in young, healthy volunteers. We wished to examine whether these effects also occurred in the elderly, and conducted a crossover study in 13 men with a mean age of 73 years (range 66-84), who each received intravenous infusions of 1.5 l of Ringers acetate and of isotonic saline. Isotonic saline induced mild changes in plasma sodium (mean +1.5 mmol.l(-1)), plasma chloride (+3 mmol.l(-1)) and standard bicarbonate (-2 mmol.l(-1)). Three hours after starting the infusions, 68% of the Ringers acetate and 30% of the infused saline had been excreted (p < 0.01). The glomerular filtration rate increased in response to both fluids, but more after the Ringers acetate (p < 0.03). Pre-infusion fluid retention, as evidenced by high urinary osmolality (> 700 mOsmol.kg(-1)) and/or creatinine (> 7 mmol.l(-1)), was a strong factor governing the responses to both fluid loads.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-124625 (URN)10.1111/anae.13301 (DOI)000368004000006 ()26669730 (PubMedID)
Note

Funding Agencies|Stockholm City Council; Kleberg Foundation

Available from: 2016-02-09 Created: 2016-02-08 Last updated: 2017-11-30
Hahn, R. & Lyons, G. (2016). The half-life of infusion fluids An educational review. European Journal of Anaesthesiology, 33(7), 475-482
Open this publication in new window or tab >>The half-life of infusion fluids An educational review
2016 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 7, p. 475-482Article, review/survey (Refereed) Published
Abstract [en]

An understanding of the half-life (T-1/2) of infused fluids can help prevent iatrogenic problems such as volume overload and postoperative interstitial oedema. Simulations show that a prolongation of the T-1/2 for crystalloid fluid increases the plasma volume and promotes accumulation of fluid in the interstitial fluid space. The T-1/2 for crystalloids is usually 20 to 40 min in conscious humans but might extend to 80 min or longer in the presence of preoperative stress, dehydration, blood loss of amp;lt;1 l or pregnancy. The longest T-1/2 measured amounts to between 3 and 8 h and occurs during surgery and general anaesthesia with mechanical ventilation. This situation lasts as long as the anaesthesia. The mechanisms for the long T-1/2 are only partly understood, but involve adrenergic receptors and increased renin and aldosterone release. In contrast, the T-1/2 during the postoperative period is usually short, about 15 to 20 min, at least in response to new fluid. The commonly used colloid fluids have an intravascular persistence T-1/2 of 2 to 3 h, which is shortened by inflammation. The fact that the elimination T-1/2 of the infused macromolecules is 2 to 6 times longer shows that they also reside outside the bloodstream. With a colloid, fluid volume is eliminated in line with its intravascular persistence, but there is insufficient data to know if this is the same in the clinical setting.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2016
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-130398 (URN)10.1097/EJA.0000000000000436 (DOI)000379343600002 ()27058509 (PubMedID)
Note

Funding Agencies|Baxter Healthcare

Available from: 2016-08-15 Created: 2016-08-05 Last updated: 2017-11-28
Zdolsek, J., Bergek, C., Lindahl, T. & Hahn, R. (2015). Colloid osmotic pressure and extravasation of plasma proteins following infusion of Ringers acetate and hydroxyethyl starch 130/0.4. Acta Anaesthesiologica Scandinavica, 59(10), 1303-1310
Open this publication in new window or tab >>Colloid osmotic pressure and extravasation of plasma proteins following infusion of Ringers acetate and hydroxyethyl starch 130/0.4
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 10, p. 1303-1310Article in journal (Refereed) Published
Abstract [en]

BackgroundDuring fluid infusion therapy, plasma proteins are diluted and leak from the intravascular space, which alters the colloid osmotic pressure (COP) and potentially affects coagulation. We hypothesised that acetated Ringers and starch solution, alone or in combination, influence these mechanisms differently. Materials and methodsOn different occasions, 10 male volunteers were infused with 20ml/kg acetated Ringers and 10ml/kg 6% hyroxyethyl starch 130/0.4 (Voluven((R))) alone or in combination (first with starch solution followed by Ringers solution). Blood samples were collected every 30-min for measurements of COP, blood haemoglobin, platelets, and plasma concentrations of albumin, immunoglobulins (IgG and IgM), coagulation factor VII (FVII), fibrinogen, cystatin C, activated partial thromboplastin time (APTT) and prothrombin international normalised ratio (PT-INR). Changes were compared with the haemoglobin-derived plasma dilution. ResultsThe COP increased by 8.4% (SD 3) with starch and decreased by 26.2% (7.9) with Ringers. These infusions diluted the plasma by 23.4% (5.3) and 18.7% (4.9) respectively. The COP changes in the combined experiment followed the same pattern as the individual infusions. Albumin and IgG changes in excess of the plasma dilution were very subtle. The intravascular contents of the IgM and platelets decreased, whereas FVII, fibrinogen and cystatin C increased. PT-INR increased by 1/3 of the plasma dilution, whereas changes in APTT did not correlate with the plasma dilution. ConclusionsThe starch increased COP and only minor capillary leak occurred in healthy volunteers. The fluid-induced plasma dilution correlated with mild impairment of the extrinsic coagulation pathway but not of the intrinsic pathway.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-122412 (URN)10.1111/aas.12558 (DOI)000362589100010 ()26079310 (PubMedID)
Note

Funding Agencies|Stockholm City Council [20070421]; Ostergotland County Council [156791]

Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-12-01
Hahn, R. (2015). Fluid absorption and the ethanol monitoring method. Acta Anaesthesiologica Scandinavica, 59(9), 1081-1093
Open this publication in new window or tab >>Fluid absorption and the ethanol monitoring method
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 9, p. 1081-1093Article, review/survey (Refereed) Published
Abstract [en]

BackgroundFluid absorption is a well-known complication of endoscopic surgeries, such as transurethral prostatic resection and transcervical endometrial resection. Absorption of electrolyte-free fluid in excess of 1L, which occurs in 5% to 10% of the operations, markedly increases the risk of adverse effects from the cardiovascular and neurological systems. Absorption of isotonic saline, which is used with the new bipolar resection technique, will change the scenario of adverse effects in a yet unknown way. Hyponatremia no longer occurs, but marking the saline with ethanol reveals that fluid absorption occurs just as much as with monopolar prostate resections. MethodsEthanol monitoring is a method for non-invasive indication and quantification of fluid absorption that has been well evaluated. By using an irrigating fluid that contains 1% of ethanol, updated information about fluid absorption can be obtained at any time perioperatively by letting the patient breathe into a hand-held alcolmeter. ResultsRegression equations and nomograms with variable complexity are available for estimating how much fluid has been absorbed, both when the alcolmeter is calibrated to show the blood ethanol level and when it is calibrated to show the breath ethanol concentration. Examples of how such estimations should be performed are given in this review article. ConclusionsThe difficulty is that the anesthesiologist must be aware of how the alcolmeter is calibrated (for blood or breath) and be able to distinguish between the intravascular and extravascular absorption routes, which give rise to different patterns and levels of breath ethanol concentrations.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121732 (URN)10.1111/aas.12550 (DOI)000360982900001 ()25952458 (PubMedID)
Available from: 2015-10-06 Created: 2015-10-05 Last updated: 2017-12-01
Bergek, C., Zdolsek, J. H. & Hahn, R. (2015). Non-invasive blood haemoglobin and plethysmographic variability index during brachial plexus block. British Journal of Anaesthesia, 114(5), 812-817
Open this publication in new window or tab >>Non-invasive blood haemoglobin and plethysmographic variability index during brachial plexus block
2015 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 114, no 5, p. 812-817Article in journal (Refereed) Published
Abstract [en]

Background Plethysmographic measurement of haemoglobin concentration (SpHb  ), pleth variability index (PVI), and perfusion index (PI) with the Radical-7 apparatus is growing in popularity. Previous studies have indicated that SpHb  has poor precision, particularly when PI is low. We wanted to study the effects of a sympathetic block on these measurements.

Methods Twenty patients underwent hand surgery under brachial plexus block with one Radical-7 applied to each arm. Measurements were taken up to 20 min after the block had been initiated. Venous blood samples were also drawn from the non-blocked arm.

Results During the last 10 min of the study, SpHb  had increased by 8.6%. The PVI decreased by 54%, and PI increased by 188% in the blocked arm (median values). All these changes were statistically significant. In the non-blocked arm, these parameters did not change significantly.

Conclusions Brachial plexus block significantly altered SpHb  , PVI, and PI, which indicates that regional nervous control of the arm greatly affects plethysmographic measurements obtained by the Radical-7. After the brachial plexus block, SpHb  increased and PVI decreased.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option B, 2015
Keywords
haemoglobinometry; nerve blockade; perfusion; photoplethysmography; vasodilation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-118861 (URN)10.1093/bja/aeu484 (DOI)000354153500015 ()25603961 (PubMedID)
Available from: 2015-06-08 Created: 2015-06-04 Last updated: 2017-12-04
Li, Y., He, R., Ying, X. & Hahn, R. (2015). Ringer's lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial. BMC Anesthesiology, 15
Open this publication in new window or tab >>Ringer's lactate, but not hydroxyethyl starch, prolongs the food intolerance time after major abdominal surgery; an open-labelled clinical trial
2015 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 15Article in journal (Refereed) Published
Abstract [en]

Background: The infusion of large amounts of Ringers lactate prolongs the functional gastrointestinal recovery time and increases the number of complications after open abdominal surgery. We performed an open-labelled clinical trial to determine whether hydroxyethyl starch or Ringers lactate exerts these adverse effects when the surgery is performed by laparoscopy. Methods: Eighty-eight patients scheduled for major abdominal cancer surgery (83% by laparoscopy) received a first-line fluid treatment with 9 ml/kg of either 6% hydroxyethyl starch 130/0.4 (Voluven) or Ringers lactate, just after induction of anaesthesia; this was followed by a second-line infusion with 12 ml/kg of either starch or Ringers lactate over 1 hour. Further therapy was managed at the discretion of the attending anaesthetist. Outcome data consisted of postoperative gastrointestinal recovery time, complications and length of hospital stay. Results: The order of the infusions had no impact on the outcome. Both the administration of greater than= 2 L of Ringers lactate and the development of a surgical complication were associated with a longer time period of paralytic ileus and food intolerance (two-way ANOVA, P less than 0.02), but only surgical complications prolonged the length of hospital stay (P less than 0.001). The independent effect of Ringers lactate and complications of food intolerance time amounted to 2 days each. The infusion of greater than= 1 L of hydroxyethyl starch did not adversely affect gastrointestinal recovery. Conclusions: Ringers lactate, but not hydroxyethyl starch, prolonged the gastrointestinal recovery time in patients undergoing laparoscopic cancer surgery. Surgical complications prolonged the hospital stay.

Place, publisher, year, edition, pages
BioMed Central / Springer Verlag (Germany), 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-119590 (URN)10.1186/s12871-015-0053-5 (DOI)000355399400001 ()25943360 (PubMedID)
Note

Funding Agencies|Qianjiang Talents Project of the Technology Office in Zhejiang province, PR of China [2012R10033]; Ostergotland City Council, Sweden [LiO-297751]

Available from: 2015-06-23 Created: 2015-06-22 Last updated: 2017-12-04
Ljunggren, S., Nyström, T. & Hahn, R. G. (2014). Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance: Prospective observational study. European Journal of Anaesthesiology, 31(2), 110-116
Open this publication in new window or tab >>Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance: Prospective observational study
2014 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 2, p. 110-116Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being.

OBJECTIVES: To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance.

DESIGN: Prospective observational study.

SETTING: Surgery department and orthopaedic ward at two regional hospitals.

PATIENTS: Twenty-two patients (mean age 68 years) scheduled for elective hip replacement.

INTERVENTIONS: A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery.

MAIN OUTCOME MEASURES: Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline.

RESULTS: The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA).

CONCLUSION: Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102530 (URN)10.1097/EJA.0000000000000017 (DOI)000329191400008 ()24257458 (PubMedID)
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2017-12-06Bibliographically approved
Hahn, R., Bahlmann, H. & Nilsson, L. (2014). Dehydration and fluid volume kinetics before major open abdominal surgery. Acta Anaesthesiologica Scandinavica, 58(10), 1258-1266
Open this publication in new window or tab >>Dehydration and fluid volume kinetics before major open abdominal surgery
2014 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, no 10, p. 1258-1266Article in journal (Refereed) Published
Abstract [en]

Introduction: Assessment of dehydration in the preoperative setting is of potential clinical value. The present study uses urine analysis and plasma volume kinetics, which have both been validated against induced changes in body water in volunteers, to study the incidence and severity of dehydration before open abdominal surgery begins. Methods: Thirty patients (mean age 64 years) had their urine analysed before major elective open abdominal surgery for colour, specific weight, osmolality and creatinine. The results were scored and the mean taken to represent a dehydration index. Thereafter, the patients received an infusion of 5ml/kg of Ringers acetate intravenously for over 15min. Blood was sampled for 70min and the blood haemoglobin concentration used to estimate the plasma volume kinetics. Results: Distribution of fluid occurred more slowly (Pless than0.01) and the elimination half-life was twice as long (median 40min, not significant) in the 11 patients (37%) diagnosed to be moderately dehydrated as compared with euhydrated patients. The dehydration index indicated that the fluid deficit in these patients corresponded to 2.5% of the body weight, whereas the deficit in the others was 1%. In contrast, the 11 patients who later developed postoperative nausea and vomiting had a very short elimination half-life, only 9min (median, Pless than0.01). These patients were usually euhydrated but had microalbuminuria (Pless than0.03) and higher natriuresis (Pless than0.01). Conclusions: The degree of dehydration before major surgery was modest as evidenced both by urine sampling and volume kinetic analysis.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-112464 (URN)10.1111/aas.12416 (DOI)000343826500010 ()25307711 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland [LiO-314271, LiO-357621]

Available from: 2014-11-28 Created: 2014-11-28 Last updated: 2017-12-05Bibliographically approved
Li, Y., He, R., Ying, X. & Hahn, R. (2014). Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia. Clinics, 69(12), 809-816
Open this publication in new window or tab >>Dehydration, hemodynamics and fluid volume optimization after induction of general anesthesia
2014 (English)In: Clinics, ISSN 1807-5932, E-ISSN 1980-5322, Vol. 69, no 12, p. 809-816Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins. METHODS: Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n = 86) or Ringers lactate (n = 25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringers lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples. RESULTS: Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringers). The optimized stroke volume index was clustered around 35-40 ml/m(2)/beat. Additional fluid boluses increased the stroke volume by greater than= 10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringers) times over the infused volume. CONCLUSIONS: Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.

Place, publisher, year, edition, pages
Faculdade de Medicina / USP, 2014
Keywords
Fluid Therapy; Central Hemodynamics; Dehydration; General Anesthesia
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114266 (URN)10.6061/clinics/2014(12)04 (DOI)000348215800004 ()
Note

Funding Agencies|Qianjiang Talents Project of the Technology Office in Zhejiang province, PR China [2012R10033]; Ostergotland City Council, Sweden [LiO-297751]

Available from: 2015-02-16 Created: 2015-02-16 Last updated: 2017-12-04
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ORCID iD: ORCID iD iconorcid.org/0000-0002-1528-3803

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