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  • 1. Ameur, Safia
    et al.
    Carlander, Kristina
    Grundström, Kristin
    Hallberg, Pernilla
    Lundgren, Kristin
    Lundquist, Per-Gotthard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery.
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Att lära bronkoskopi i simulator gav mer fingerfärdighet än omdöme2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, p. 2694-2699Article in journal (Other academic)
  • 2. Bergström, Annika
    et al.
    Rüter, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Vikström, Tore
    Förmågeanalys av den katastrofmedicinska beredskapen inom Landstinget i Östergötland2008Report (Other academic)
  • 3.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Education and training in disaster medicine2005In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 94, no 4, p. 300-310Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 4.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Education and training in disaster medicine- time for a scientific approach2003In: International Journal of Disaster Medicine, ISSN 1503-1438, E-ISSN 1755-4713, Vol. 1Article in journal (Refereed)
  • 5.
    Lennquist, Sten
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Introduction to the third "Focus-on" issue specially devoted to papers within the field of the ESTES section for Disaster and Military Surgery2011In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 37, no 1, p. 1-2Article in journal (Other academic)
    Abstract [en]

    Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

  • 6.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Protocol for reports from major accidents and disasters in the International Journal of Disaster Medicine2003In: International Journal of Disaster Medicine, ISSN 1503-1438, E-ISSN 1755-4713, Vol. 1, p. 79-86Article in journal (Refereed)
  • 7.
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    The Emergotrain system for training and testing disaster preparedness: 15 years of experience2003In: International Journal of Disaster Medicine, ISSN 1503-1438, E-ISSN 1755-4713, Vol. 1, p. 25-34Article in journal (Refereed)
  • 8.
    Lundberg, L
    et al.
    Swedish Armed Forces Centre for Defence Medicine/University of Gothenburg, Sweden.
    Jonsson, Andreas
    Swedish Armed Forces Medical Centre for Defence Medicine/University College of Borås, Sweden.
    Vikström, Thore
    Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Rüter, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Weak and strong points in training of prehospital command and control. Are results possible to measure?2008In: International Review of the Armed Forces Medical Services / Revue internationale des services de santé des forces armées, ISSN 0259-8582, Vol. 81, no 3, p. 131-134Article in journal (Refereed)
    Abstract [en]

    In evaluation of military training and exercises, shortcomings are often expressed in general terms. This makes it difficult to know exactly what needs improvement. Lessons that should be learned are merely observed. It is necessary to apply a systematic and quantitative approach to this problem and tools are now accessible. Performance indicators have already been tested on a military exercise and have proved to be possible to apply. The present study has looked into these performance indicators in more detail. The standards set for civilian use should be able to meet in ten out of eleven cases. The performance indicator where the goal is most likely not to be achieved is to have the first patient evacuated within 15 minutes. The next step is to apply this set of indicators on basic military training, formal pre-mission training as well as applied exercises in the mission area.

  • 9. Månsson, Emeli
    et al.
    Rüter, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Femoral shaft fractures and the prehospital use of traction splints2006In: Akuttjournalen: Tidsskrift for avansert akuttmedisin, ISSN 0805-6129, E-ISSN 1500-7480, Vol. 14, p. 26-29Article in journal (Refereed)
    Abstract [en]

        

  • 10.
    Nilsson, Heléne
    et al.
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Rüter, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Attitudes on the use of priority tags2007In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 15, p. 71-73Article in journal (Refereed)
    Abstract [en]

    Prioritising of victims as well as the use of priority tags in different colours is an important part of all training in patient management at disasters and major incidents. The actual use of priority tags in incidents and disasters has so far not been systematically studied. The aim of this study was to demonstrate attitudes among researchers as well as prehospital personnel on the actual use of priority tags. In 38 KAMEDO reports issued by the Swedish National Board of Health and Welfare describing major incidents and disasters from 1977-2004, we found no documentation on the use of priority tags. In a questionnaire to personnel within the prehospital medical system 133 (68%) replied that they only have used priority tags in training. 20 (10%) had used priority tags in a real accident/incident and 43 (21%) answered that they have never used priority tags. Reports from incidents should include the issues on the use of priority tags and clearly defi ned criteria on prioritising and labelling of patients at an incident/disaster, as well as in daily work, should be defi ned.

  • 11.
    Olofsson, Pia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wikström, Thore
    Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Nagelkerke, N
    Abu-Zidan, Fikiri M.
    UAE University.
    Wang, J
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Multipel Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock2009In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 98, no 1, p. 41-47Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haernorrhagic shock compared with conventional surgery.

    Methods: Eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. The animals were bled to a mean arterial pressure of 50 mm Hg for 30 minutes, after which they were resuscitated and had laparotomy. They were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel injuries and early rapid multiple bowel ligation group (n=9). Repeated measurement analysis of variance was used for analysis.

    Results: There was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. Lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. There were no significant differences in mean arterial pressure, cardiac output, stroke volume or systemic vascular resistance between the groups. The mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (SEM) minutes, compared with 116.4 (1.74) (SEM) minutes in the conventional surgery group, p = <0.001).

    Conclusions: Damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.

  • 12.
    Prytz, Erik G.
    et al.
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Rybing, Jonas
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Carlström, Eric
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Khorram-Manesh, Amir
    Prehospital and Disaster Medicine Centre, Sahlgrenska Academy, Gothenburg, Sweden.
    Jonson, Carl-Oscar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Exploring prehospital C2-work during a mass gathering event2015In: International Journal of Emergency Services, ISSN 2047-0894, E-ISSN 2047-0908, Vol. 4, no 2, p. 227-241Article in journal (Refereed)
    Abstract [en]

    Purpose– The purpose of this paper is to explore the workload and shared workload awareness in a staff performing command and control (C2) work during a planned major incident (MI) empirical case in Sweden. Design/methodology/approach– Data on workload and shared awareness were collected during live C2-work using qualitative observations and in-situ interviews mixed with quantitative questionnaires. Findings– A content analysis of the qualitative data revealed categories of workload sources. Quantified workload estimates showed changes in workload levels over time and staff roles, which were also contextualized using the results of the qualitative data. Data on shared awareness indicated that team workload awareness shifted over time according to common patterns. This study demonstrates a promising methodology to study C2-related factors during live EMS work. Research limitations/implications– The observed variations in workload imply that research that relies only on post-task measurements of workload may be inaccurate. Future research could use this method to investigate the connection between workload and performance during different types of MIs. Originality/value– The results can be used to inform future Göteborgsvarvet C2-teams in terms of when, why, and for whom task load changes, which would support predictive allocation of resources.

  • 13.
    Prytz, Erik G.
    et al.
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Rybing, Jonas
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Jonson, Carl-Oscar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Petterson, Albin
    Linköping University.
    Berggren, Peter
    Swedish Defence Research Agency, Sweden.
    Johansson, Björn
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    An exploratory study of a low-level shared awareness measure using mission-critical locations during an emergency exercise2015In: Proceedings of the Human Factors and Ergonomics Society 59th Annual Meeting, Sage Publications, 2015, Vol. 59, no 1, p. 1152-1156Conference paper (Refereed)
    Abstract [en]

    A shared awareness of other teams’ roles and tasks has been linked to successful performance in joint ventures. However, emergency management organizations responding to incidents do not always share critical information necessary for maintaining shared awareness. An instrument called Shared Priorities has previously been applied to measure aspects of shared situation awareness at level 2 and 3 in Endsley’s (1995) model. This paper reports on a shared awareness instrument focused on level 1 situation awareness and its associated level of team shared awareness. Participants in a large emergency response exercise were asked to locate and rank geographical locations based on importance for overall mission success. The results show that organizations tended to rank locations relevant for their own work higher than positions relevant to other organization’s tasks. The different organizations displayed different levels of inter-rater agreement within themselves concerning the ranking of these positions.

  • 14. Rüter, Anders
    et al.
    Dahlén, Nils
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Utvärdering av prehospital sjukvårdsledningsinsats mot mätbara mål2004In: Akuttjournalen: Tidsskrift for avansert akuttmedisin, ISSN 0805-6129, E-ISSN 1500-7480, Vol. 12, p. 108-109Article in journal (Refereed)
  • 15.
    Rüter, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Lundmark, Torsten
    Ödmansson, Ernst
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    The development of a national doctrine for management of major incidents and disasters2006In: Akuttjournalen: Tidsskrift for avansert akuttmedisin, ISSN 0805-6129, E-ISSN 1500-7480, Vol. 14, p. 177-181Article in journal (Refereed)
    Abstract [en]

       

  • 16. Rüter, Anders
    et al.
    Nilsson, Helene
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Prehospital sjukvårdsledning - en konceptutbildning med certifiering2004In: Akuttjournalen: Tidsskrift for avansert akuttmedisin, ISSN 0805-6129, E-ISSN 1500-7480, Vol. 12, p. 148-149Article in journal (Refereed)
  • 17.
    Rüter, Anders
    et al.
    Linköping University, Department of Biomedicine and Surgery, Division of surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Nilsson, Heléne
    Linköping University, Department of Biomedicine and Surgery, Division of surgery. Linköping University, Faculty of Health Sciences.
    Wikström, Thore
    Linköping University, Department of Biomedicine and Surgery, Division of surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Performance indicators as quality control for testing and evaluating hospital management groups: a pilot study.2006In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 21, no 6, p. 423-426Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: An important issue in disaster medicine is the establishment of standards that can be used as a template for evaluation. With the establishment of standards, the ability to compare results will improve, both within and between different organizations involved in disaster management.

    OBJECTIVE: Performance indicators were developed for testing in simulations exercises with the purpose of evaluating the skills of hospital management groups. The objective of this study is to demonstrate how these indicators can be used to create numerically expressed results that can be compared.

    METHODS: Three different management groups were tested in standardized simulation exercises. The testing took place according to the organization's own disaster plan and within their own facilities. Trained observers used a pre-designed protocol of performance indicators as a template for the evaluation.

    RESULTS: The management group that scored lowest in management skills also scored lowest in staff skills. CONCLUSION: The use of performance indicators for evaluating the management skills of hospital groups can provide comparable results in testing situations and could provide a new tool for quality improvement of evaluations of real incidents and disasters.

  • 18.
    Rüter, Anders
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Vikström, Tore
    Linköping University, Department of Clinical and Experimental Medicine, Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Performance indicators - from theory to implementation: one method of scientific approach to disaster medicine2009In: Urgence Pratique, ISSN 1244-1791, Vol. 93, p. 41-44Article in journal (Other academic)
    Abstract [en]

    The objective of this paper is to demonstrate a possible tool for the use of a quantitative research method that can be applied in disaster medicine.

    Method: Stepwise, using the technique of concept and process modelling, key processes in forms of performance indicators for command and control at disaster and major incidents were identified. A standard was linked to each indicator. Based in these indicators, an educational program was developed. In this program results from examinations were expressed in numbers and can thereby allow statistical methods to be applied.

    Results: Application of this model on prehospital command and control demonstrated weak and strong points. The method has been implemented in 13 out 21 regions and is used as a quality control tool.

    Conclusions: The use of performance indicators developed by using results from modelling processes could possibly serve as a tool for conducting quantitative research in disaster medicine.

  • 19.
    Rüter, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    Computer simulation as a tool for testing disaster preparedness2006In: Akuttjournalen: Tidsskrift for avansert akuttmedisin, ISSN 0805-6129, E-ISSN 1500-7480, Vol. 14, p. 33-35Article in journal (Refereed)
  • 20.
    Wang, Jianpu
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Pathophysiology and treatment of chlorine gas-induced lung injury: an experimental study in pigs2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    One of the most threatening scenarios in disaster medicine is the accidental release of toxic gases with the exposure of many people. In this respect, chlorine gas remains a significant threat due to its abundant use and transport through densely populated areas in modem society. Access to a simple and effective method of treatment that could be started early would be of great value. The main purpose of this study was to test a series of hypotheses related to chlorine gas lung injury and its treatment.

    Anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 parts per million in air) using a closed system with a ventilator connected to gas cylinders. Plasma endothelin-1 (ET -1) and pro inflammatory cytokines were evaluated for 5 hours after injury while hemodynamics, gas exchange and lung mechanics were followed for 23 hours. Histopathology and lung water balance were assessed at the end of the experiment.

    Chlorine gas exposure induced a rise in circulating ET-1 and circulating cytokines (TNF-α, and IL-1ß, IL-6). Pretreatment or treatment with tezosentan, a potent dual endothelin receptor antagonist, reduced the deterioration of pulmonary function induced by chlorine gas inhalation. Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport. Nebulized budesonide given within 30 minutes after chlorine gas lung injury was effective in preventing further progression of lung dysfunction but the effect of treatment given beyond 60 minutes was less efficient. The positive effects on pulmonary function and lung water were similar whether corticosteroids were given by aerosol or intravenously. Combined treatment with nebulized terbutaline and budesonide was associated with better recovery of lung function than either drug alone.

    In conclusion, these studies outline the early pathophysiology of chlorine gas injury. They show that the endothelin system mediates the early pulmonary hypertensive and also to some extent the brochoconstrictive responses to inhaled chlorine gas. The work supports early administration of corticosteroids and ß2-agonists for individuals that are exposure to chlorine gas. In addition, early prone positioning of patients with severe chlorine gas lung injury may be useful.

    List of papers
    1. Effects of endothelin receptor antagonism on acute lung injury induced by chlorine gas
    Open this publication in new window or tab >>Effects of endothelin receptor antagonism on acute lung injury induced by chlorine gas
    Show others...
    2006 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 34, no 6, p. 1731-1737Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To test the hypothesis that the endothelin system is involved in chlorine gas-induced lung injury.

    DESIGN: Experimental study.

    SETTING: Academic research laboratory.

    SUBJECTS: Twenty-four domestic juvenile pigs.

    INTERVENTIONS: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million in air) for 20 mins and then randomly allocated to four groups (n = 6 in each group). The tezosentan pretreatment group received the dual endothelin receptor antagonist tezosentan 20 mins before and hyperoxic gas (Fio2 0.6) after chlorine gas exposure. The tezosentan postinjury treatment group received hyperoxic gas after chlorine gas exposure and tezosentan 60 mins later. Animals in the oxygen group received hyperoxic gas after chlorine gas exposure. Pigs in the fourth group (air) were ventilated with room air (Fio2 0.21) throughout the experiment.

    MEASUREMENTS AND MAIN RESULTS: Hemodynamics, gas exchange, lung mechanics, and plasma endothelin-1 were evaluated for 6 hrs. Chlorine gas exposure induced an increase in circulating endothelin-1 by 90% (p < .05). The acute chlorine gas-induced rise in pulmonary vascular resistance was partly blocked by tezosentan pretreatment (p < .001). Tezosentan postinjury treatment also decreased pulmonary vascular resistance to levels significantly lower than in the air and oxygen groups (p < .001). Recovery of peak airway pressure was better in the tezosentan-treated groups than in the air group. There were significant linear relationships between circulating endothelin-1 and pulmonary vascular resistance (r = .47, p < .001) and endothelin-1 and peak airway pressure (r = .41, p < .001). These relationships were modified by tezosentan.

    CONCLUSIONS: Tezosentan modified chlorine gas-induced pulmonary dysfunction, indicating that the endothelin system is involved in this mode of acute lung injury.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-37843 (URN)10.1097/01.CCM.0000218815.46611.63 (DOI)39627 (Local ID)39627 (Archive number)39627 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2018-03-26Bibliographically approved
    2. Inhaled budesonide in experimental chlorine gas lung injury: influence of time interval between injury and treatment
    Open this publication in new window or tab >>Inhaled budesonide in experimental chlorine gas lung injury: influence of time interval between injury and treatment
    2002 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 28, no 3, p. 352-357Article in journal (Refereed) Published
    Abstract [en]

    Objective: To examine the time window between injury and treatment during which nebulized corticosteroid lessens lung injury induced by chlorine gas inhalation.

    Design: An experimental laboratory study.

    Setting: Academic research laboratory.

    Subjects: Twenty-four juvenile female pigs.

    Interventions: Twenty-four mechanically ventilated pigs were exposed to chlorine gas (400 PPM in air) for 20 min, then divided into four groups (six in each group). Nebulized budesonide (BUD) was given immediately (BUD 0 min), 30 min (BUD 30 min) or 60 min (BUD 60 min) after chlorine gas exposure. Six pigs receiving nebulized saline served as controls.

    Measurements and main results: Hemodynamics, gas exchange and lung mechanics were evaluated for 5 h after chlorine gas exposure. All animals had an immediate increase in airway and pulmonary artery pressure and a sharp drop of arterial oxygenation. The mean arterial oxygen tension of BUD 0 min and BUD 30 min animals was significantly higher than in the control and the BUD 60 min groups (p<0.001). The recovery of lung compliance in the BUD 0 min and the BUD 30 min groups was significantly more rapid than in the control and the BUD 60 min groups (p<0.001). The pulmonary wet to dry weight ratio was greater in the control group than in the BUD-treated groups (p<0.05).

    Conclusion: Treatment with inhaled budesonide immediately or 30 min after chlorine gas lung injury had similar positive effects on symptoms and signs of pulmonary injury, whereas treatment delayed for 60 min was less effective.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25446 (URN)10.1007/s00134-001-1175-4 (DOI)9892 (Local ID)9892 (Archive number)9892 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    3. Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury
    Open this publication in new window or tab >>Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury
    2004 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, no 4, p. 850-862Article in journal (Refereed) Published
    Abstract [en]

    Background: The pathophysiology and treatment of chlorine gas-induced acute lung injury is poorly characterized and based on anecdotal data. This study aimed to assess the effects of aerosolized beta-2 adrenergic agonist and corticosteroid therapy on chlorine gas-induced lung injury.

    Methods: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million for 20 minutes), then assigned randomly 30 minutes later to receive aerosolized terbutaline, budesonide, terbutaline followed by budesonide or placebo (6 pigs in each group). Hemodynamics, gas exchange, and lung mechanics were evaluated for another 5 hours.

    Results: All the animals demonstrated an immediate increase in airway and pulmonary artery pressure as well as sharp drops in arterial oxygen tension (PaO2) and lung compliance (C L). Recovery of PaO2 and CL was greatest in the terbutaline plus budesonide group, but therapy with terbutaline and budesonide alone also was associated with significant improvement in PaO2 and CL, as compared with placebo.

    Conclusions. Treatment of acute chlorine gas lung injury with aerosolized terbutaline followed by aerosolized budesonide improved lung function. Combined treatment was more effective than treatment with either drug alone.

    Keywords
    acute lung injury, aerosol, chlorine gas, beta-2-adrenergic agonist, corticosteroid, experimental study, lung function
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-46235 (URN)10.1097/01.TA.0000078689.45384.8B (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
    4. Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury
    Open this publication in new window or tab >>Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury
    2002 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 46, no 9, p. 1094-1102Article in journal (Refereed) Published
    Abstract [en]

    Background: Chlorine gas may induce severe acute lung injury. Improvement of pulmonary gas exchange in patients and animals with acute lung injury nursed in the prone position was observed in recent years. The purpose of this study was to evaluate the effects of prone and supine positions on pulmonary and cardiovascular functions following experimental chlorine gas lung injury.

    Methods: Twenty anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 p.p.m. in air) for 20 min in the supine position, then assigned randomly to ventilation in the supine or prone positions (n=10 in each group). Hemodynamics, gas exchange, lung mechanics and oxygen transport were evaluated for 5 h.

    Results: All animals showed severe pulmonary dysfunction immediately after chlorine gassing with a threefold increase in pulmonary vascular resistance index, a drop in arterial oxygenation (12.3±1.3 kPa to 5.4±0.7 kPa) and a fall in lung-thorax compliance (22±1 ml cmH2O−1 to 8±2 ml cmH2O−1). Venous admixture (Qs/Qt) improved in animals in the prone position while there was no change in the supine position (prone 32±11% vs. supine 42±9% at 5 h,P<0.05). Lung-thorax compliance improved significantly with time in the prone group only (P<0.01). Oxygen delivery increased significantly in prone animals compared with animals nursed in the supine posture (P<0.001).

    Conclusion: Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24824 (URN)10.1034/j.1399-6576.2002.460907.x (DOI)9221 (Local ID)9221 (Archive number)9221 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    5. Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs
    Open this publication in new window or tab >>Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs
    2005 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 2, p. 183-190Article in journal (Refereed) Published
    Abstract [en]

    Background:  The accidental release of chlorine gas is a constant threat in urban areas. The purpose of this randomized, blinded, controlled experiment was to examine the effects of post-injury administration of inhaled or intravenous corticosteroid in chlorine gas-injured pigs followed for 23 h.

    Methods:  Anaesthetized, ventilated pigs (n = 24) in the prone position were exposed to chlorine gas (400 parts per million in air) (1160 mg/m3) for 15 min, then randomly allocated to receive inhaled budesonide (BUD) and intravenous placebo, intravenous betamethasone (BETA) and inhaled placebo or inhaled and intravenous placebo. Haemodynamics, gas exchange and lung mechanics were evaluated for 23 h after exposure to chlorine gas.

    Results:  Airway and pulmonary artery pressures increased and arterial oxygenation fell sharply (from 13.5 ± 0.8 to 6.7 ± 0.9 kPa, P < 0.001) after chlorine gas exposure. These immediate changes were followed by a gradual improvement over 5–7 h to a stable level of dysfunction for the rest of the experiment in placebo animals. Arterial oxygen tension, pulmonary vascular resistance and airway pressure recovered faster and more completely in the budesonide and betamethasone groups than in the placebo group (P < 0.01). Lung wet weight to dry weight ratios were greater in the placebo group than in the budesonide and betamethasone groups (6.34 ± 0.59 vs. 5.56 ± 0.38 and 5.53 ± 0.54, respectively, P < 0.05). There was a trend towards lower histological injury scores compared with placebo in animals that received budesonide (P = 0.05) or betamethasone (P = 0.07).

    Conclusion:  Treatment of chlorine gas lung injury with nebulized budesonide or intravenous betamethasone had similar positive effects on recovery of lung function.

    Keywords
    Acute lung injury, Chlorine gas, Experimental study, Intravenous corticosteroid, Nebulized corticosteroid, Randomized controlled study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-45510 (URN)10.1111/j.1399-6576.2004.00563.x (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
  • 21.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Oldner, A.
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Winskog, C.
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Edston, Erik
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Effects of endothelin receptor antagonism on acute lung injury induced by chlorine gas2006In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 34, no 6, p. 1731-1737Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that the endothelin system is involved in chlorine gas-induced lung injury.

    DESIGN: Experimental study.

    SETTING: Academic research laboratory.

    SUBJECTS: Twenty-four domestic juvenile pigs.

    INTERVENTIONS: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million in air) for 20 mins and then randomly allocated to four groups (n = 6 in each group). The tezosentan pretreatment group received the dual endothelin receptor antagonist tezosentan 20 mins before and hyperoxic gas (Fio2 0.6) after chlorine gas exposure. The tezosentan postinjury treatment group received hyperoxic gas after chlorine gas exposure and tezosentan 60 mins later. Animals in the oxygen group received hyperoxic gas after chlorine gas exposure. Pigs in the fourth group (air) were ventilated with room air (Fio2 0.21) throughout the experiment.

    MEASUREMENTS AND MAIN RESULTS: Hemodynamics, gas exchange, lung mechanics, and plasma endothelin-1 were evaluated for 6 hrs. Chlorine gas exposure induced an increase in circulating endothelin-1 by 90% (p < .05). The acute chlorine gas-induced rise in pulmonary vascular resistance was partly blocked by tezosentan pretreatment (p < .001). Tezosentan postinjury treatment also decreased pulmonary vascular resistance to levels significantly lower than in the air and oxygen groups (p < .001). Recovery of peak airway pressure was better in the tezosentan-treated groups than in the air group. There were significant linear relationships between circulating endothelin-1 and pulmonary vascular resistance (r = .47, p < .001) and endothelin-1 and peak airway pressure (r = .41, p < .001). These relationships were modified by tezosentan.

    CONCLUSIONS: Tezosentan modified chlorine gas-induced pulmonary dysfunction, indicating that the endothelin system is involved in this mode of acute lung injury.

  • 22.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Winskog, C.
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Edston, Erik
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs2005In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, no 2, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Background:  The accidental release of chlorine gas is a constant threat in urban areas. The purpose of this randomized, blinded, controlled experiment was to examine the effects of post-injury administration of inhaled or intravenous corticosteroid in chlorine gas-injured pigs followed for 23 h.

    Methods:  Anaesthetized, ventilated pigs (n = 24) in the prone position were exposed to chlorine gas (400 parts per million in air) (1160 mg/m3) for 15 min, then randomly allocated to receive inhaled budesonide (BUD) and intravenous placebo, intravenous betamethasone (BETA) and inhaled placebo or inhaled and intravenous placebo. Haemodynamics, gas exchange and lung mechanics were evaluated for 23 h after exposure to chlorine gas.

    Results:  Airway and pulmonary artery pressures increased and arterial oxygenation fell sharply (from 13.5 ± 0.8 to 6.7 ± 0.9 kPa, P < 0.001) after chlorine gas exposure. These immediate changes were followed by a gradual improvement over 5–7 h to a stable level of dysfunction for the rest of the experiment in placebo animals. Arterial oxygen tension, pulmonary vascular resistance and airway pressure recovered faster and more completely in the budesonide and betamethasone groups than in the placebo group (P < 0.01). Lung wet weight to dry weight ratios were greater in the placebo group than in the budesonide and betamethasone groups (6.34 ± 0.59 vs. 5.56 ± 0.38 and 5.53 ± 0.54, respectively, P < 0.05). There was a trend towards lower histological injury scores compared with placebo in animals that received budesonide (P = 0.05) or betamethasone (P = 0.07).

    Conclusion:  Treatment of chlorine gas lung injury with nebulized budesonide or intravenous betamethasone had similar positive effects on recovery of lung function.

  • 23.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Zheng, Limin
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology. Linköping University, Faculty of Health Sciences.
    Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury2004In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, no 4, p. 850-862Article in journal (Refereed)
    Abstract [en]

    Background: The pathophysiology and treatment of chlorine gas-induced acute lung injury is poorly characterized and based on anecdotal data. This study aimed to assess the effects of aerosolized beta-2 adrenergic agonist and corticosteroid therapy on chlorine gas-induced lung injury.

    Methods: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million for 20 minutes), then assigned randomly 30 minutes later to receive aerosolized terbutaline, budesonide, terbutaline followed by budesonide or placebo (6 pigs in each group). Hemodynamics, gas exchange, and lung mechanics were evaluated for another 5 hours.

    Results: All the animals demonstrated an immediate increase in airway and pulmonary artery pressure as well as sharp drops in arterial oxygen tension (PaO2) and lung compliance (C L). Recovery of PaO2 and CL was greatest in the terbutaline plus budesonide group, but therapy with terbutaline and budesonide alone also was associated with significant improvement in PaO2 and CL, as compared with placebo.

    Conclusions. Treatment of acute chlorine gas lung injury with aerosolized terbutaline followed by aerosolized budesonide improved lung function. Combined treatment was more effective than treatment with either drug alone.

  • 24.
    Wikström, Thore
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Disaster Medicine and Traumatology. Östergötlands Läns Landsting, Centre for Teaching and Research in Disaster Medicine and Traumatology, Centre for Teaching and Research in Disaster Medicine and Traumatology.
    International Society of Disaster Medicine (ISDM)2003In: International Journal of Disaster Medicine, ISSN 1503-1438, E-ISSN 1755-4713, Vol. 1, p. 77-78Article in journal (Refereed)
1 - 24 of 24
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