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  • 1.
    Andersson, Elin
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kroon, Anna
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationell kartläggning av farmakologiska rutiner och information i samband med tonsilloperation2013Conference paper (Other academic)
    Abstract [sv]

    Studien är en del i ett större nationellt projekt med syfte att kartlägga smärtbehandling vid tonsillkirurgi i samband med utformning av nationella farmakologiska riktlinjer. De vanligaste postoperativa komplikationerna vid tonsillkirurgi är postoperativt illamående och kräkningar (PONV), smärta, blödning och dehydrering. Tonsillkirurgin utförs idag antingen som dagkirurgiskt ingrepp eller som slutenvårdsingrepp med en vårdtid på ca ett dygn. Därmed sker den postoperativa vården i hemmet. Ett flertal studier har beskrivit patienternas upplevelse av höggradig smärta efter tonsillkirurgi. Obehandlad smärta leder till svårigheter att svälja och därmed otillräckligt dryckes- och matintag, vilket leder till dehydrering, ökad blödningsbenägenhet, sämre läkningsförmåga samt negativa  postoperativa beteendeförändringar hos barnet.

    Syftet var att i en nationell studie kartlägga farmakologiska rutiner och informationen i samband med tonsilloperation hos barn och ungdomar.

  • 2.
    Andersson, Elin
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kroon, Anna
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationell kartläggning av farmakologiska rutiner och information i samband med tonsilloperation2013In: Ventilen, ISSN 0348-6257, Vol. 4, no 48, p. 16-17Article in journal (Other academic)
    Abstract [sv]

    Studien är en del i ett större nationellt projekt med syfte att kartlägga smärtbehandling vid tonsillkirurgi i samband med utformning av nationella farmakologiska riktlinjer. De vanligaste postoperativa komplikationerna vid tonsillkirurgi är postoperativt illamående och kräkningar (PONV), smärta, blödning och dehydrering. Tonsillkirurgin utförs idag antingen som dagkirurgiskt ingrepp eller som slutenvårdsingrepp med en vårdtid på ca ett dygn. Därmed sker den postoperativa vården i hemmet. Ett flertal studier har beskrivit patienternas upplevelse av höggradig smärta efter tonsillkirurgi. Obehandlad smärta leder till svårigheter att svälja och därmed otillräckligt dryckes- och matintag, vilket leder till dehydrering, ökad blödningsbenägenhet, sämre läkningsförmåga samt negativa  postoperativa beteendeförändringar hos barnet.

    Syftet var att i en nationell studie kartlägga farmakologiska rutiner och informationen i samband med tonsilloperation hos barn och ungdomar.

  • 3.
    Andersson, Elin
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Kroon, Anna
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Nationell kartläggning av farmakologiska rutiner och information i samband med tonsilloperation2012In: Nationellt kvalitetsregister Öron-, Näs- och Halssjukvård: Årsrapport 2012, Nationellt kvalitetsregister för Öron-, Näs- och Halssjukvård. , 2012, p. 77-81Chapter in book (Other academic)
    Abstract [sv]

    Studien är en del i ett större nationellt projekt med syfte att kartlägga smärtbehandling vid tonsillkirurgi i samband med utformning av nationella farmakologiska riktlinjer. De vanligaste postoperativa komplikationerna vid tonsillkirurgi är postoperativt illamående och kräkningar (PONV), smärta, blödning och dehydrering. Tonsillkirurgin utförs idag antingen som dagkirurgiskt ingrepp eller som slutenvårdsingrepp med en vårdtid på ca ett dygn. Därmed sker den postoperativa vården i hemmet. Ett flertal studier har beskrivit patienternas upplevelse av höggradig smärta efter tonsillkirurgi. Obehandlad smärta leder till svårigheter att svälja och därmed otillräckligt dryckes- och matintag, vilket leder till dehydrering, ökad blödningsbenägenhet, sämre läkningsförmåga samt negativa  postoperativa beteendeförändringar hos barnet.

    Syftet var att i en nationell studie kartlägga farmakologiska rutiner och informationen i samband med tonsilloperation hos barn och ungdomar.

  • 4.
    Berkius, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Department of Anaesthesia and Intensive Care, Västervik County Hospital, Västervik, Sweden.
    Engerström, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Orwelius, Lotti
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nordlund, Peter
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping,.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten M
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences.
    A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD2013In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R211-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.

    METHODS: Fifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).

    RESULTS: HRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P=0.08 and median EQ-VAS was 50 vs.55, P<0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P=0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.

    CONCLUSIONS: HRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.

  • 5.
    De Geer, Lina
    et al.
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Oscarsson Tibblin, Anna
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 6, p. 275-279Article in journal (Refereed)
    Abstract [en]

    Context: Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established. Objective: To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days. Design: Prospective, observational cohort study. Setting: A mixed noncardiothoracic tertiary ICU in Sweden. Patients and main outcome measures NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearmans correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model. Results: An NT-pro-BNP more than 1380 ng l(-1) on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng l(-1), and 14.6% of patients below that threshold died within 30 days (log rank P 0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearmans rho 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile). Conclusion: We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an independent predictor of mortality.

  • 6.
    Engerström, Lars
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svensson, Robert
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Riskjusterad mortalitet i intensivvården: Egen analys behövs för att dra rätt slutsatser från nationella register2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 23, p. 1160-1163Article in journal (Other academic)
    Abstract [en]

    The standardized mortality ratio (SMR) based on risk-adjusted survival 30 days after admission to ICU is a quality indicator promoted by the Swedish Intensive Care Registry. We examined changes in SMR from 2007 to 2008 in our ICU. Since the numbers of deaths were about 100 per year, SMR had a fairly wide confidence limit and hence of limited value for comparison over time or between ICUs. However, analysis of performance using variable life adjusted displays based on risk adjusted survival and analysis of adverse events using the Global Trigger Tool technique were found useful.

  • 7.
    Nielsen, Niklas
    et al.
    Helsingborg Hospital.
    Wetterslev, Jorn
    Copenhagen University Hospital.
    al-Subaie, Nawaf
    University of London St Georges Hospital.
    Andersson, Bertil
    Sahlgrens University Hospital.
    Bro-Jeppesen, John
    Copenhagen University Hospital.
    Bishop, Gillian
    Campelltown Hospital.
    Brunetti, Iole
    IRCCS San Martino University Hospital.
    Cranshaw, Julius
    Royal Bournemouth Hospital.
    Cronberg, Tobias
    Skåne University Hospital.
    Edqvist, Kristin
    Central Hospital Karlstad.
    Erlinge, David
    Skåne University Hospital.
    Gasche, Yvan
    University Hospital Geneva.
    Glover, Guy
    Guys and St Thomas Hospital.
    Hassager, Christian
    Copenhagen University Hospital.
    Horn, Janneke
    University of Amsterdam.
    Hovdenes, Jan
    Oslo University Hospital.
    Johnsson, Jesper
    Helsingborg Hospital.
    Kjaergaard, Jesper
    Copenhagen University Hospital.
    Kuiper, Michael
    Leeuwarden Medical Centre.
    Langorgen, Jorund
    Haukeland Hospital.
    Macken, Lewis
    Royal N Shore Hospital.
    Martinell, Louise
    Sahlgrens University Hospital.
    Martner, Patrik
    Sahlgrens University Hospital.
    Pellis, Thomas
    Department Intens Care, Pordenone.
    Pelosi, Paolo
    IRCCS San Martino University Hospital.
    Petersen, Per
    Örebro University Hospital.
    Rundgren, Malin
    Skåne University Hospital.
    Saxena, Manoj
    St George Hospital.
    Svensson, Robert
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Stammet, Pascal
    Centre Hospital Luxembourg.
    Thoren, Anders
    Sahlgrens University Hospital.
    Unden, Johan
    Skåne University Hospital.
    Walden, Andrew
    Royal Berkshire Hospital.
    Wallskog, Jesper
    Kungalv Hospital.
    Wanscher, Michael
    Copenhagen University Hospital.
    Wise, Matthew P
    University of Wales Hospital.
    Wyon, Nicholas
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Faculty of Health Sciences.
    Aneman, Anders
    Liverpool Hospital.
    Friberg, Hans
    Skåne University Hospital.
    Target temperature management after out-of-hospital cardiac arrest-a randomized, parallel-group, assessor-blinded clinical trial-rationale and design2012In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 163, no 4, p. 541-548Article in journal (Refereed)
    Abstract [en]

    Background Experimental animal studies and previous randomized trials suggest an improvement in mortality and neurologic function with induced hypothermia after cardiac arrest. International guidelines advocate the use of a target temperature management of 32 degrees C to 34 degrees C for 12 to 24 hours after resuscitation from out-of-hospital cardiac arrest. A systematic review indicates that the evidence for recommending this intervention is inconclusive, and the GRADE level of evidence is low. Previous trials were small, with high risk of bias, evaluated select populations, and did not treat hyperthermia in the control groups. The optimal target temperature management strategy is not known. less thanbrgreater than less thanbrgreater thanMethods The TTM trial is an investigator-initiated, international, randomized, parallel-group, and assessor-blinded clinical trial designed to enroll at least 850 adult, unconscious patients resuscitated after out-of-hospital cardiac arrest of a presumed cardiac cause. The patients will be randomized to a target temperature management of either 33 degrees C or 36 degrees C after return of spontaneous circulation. In both groups, the intervention will last 36 hours. The primary outcome is all-cause mortality at maximal follow-up. The main secondary outcomes are the composite outcome of all-cause mortality and poor neurologic function (cerebral performance categories 3 and 4) at hospital discharge and at 180 days, cognitive status and quality of life at 180 days, assessment of safety and harm. less thanbrgreater than less thanbrgreater thanDiscussion The TTM trial will investigate potential benefit and harm of 2 target temperature strategies, both avoiding hyperthermia in a large proportion of the out-of-hospital cardiac arrest population.

  • 8.
    Nilsson, Andreas
    et al.
    Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL. Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences.
    Kalman, Sigga
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Arvidsson, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Difficulties in Controlling Mobilization Pain Using a Standardized Patient-Controlled Analgesia Protocol in Burns2011In: JOURNAL OF BURN CARE and RESEARCH, ISSN 1559-047X, Vol. 32, no 1, p. 166-171Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate pain relief for patients with burns during rest and mobilization with morphine according to a standard protocol for patient-controlled analgesia (PCA). Eighteen patients with a mean (SD) burned TBSA% of 26 (20) were studied for 10 days. Using a numeric rating scale (NRS, 0 = no pain and 10 = unbearable pain), patients were asked to estimate their acceptable and worst experienced pain by specifying a number on a scale and at what point they would like additional analgesics. Patients were allowed free access to morphine with a PCA pump device. Bolus doses were set according to age, (100 - age)/24 = bolus dose (mg), and 6 minutes lockout time. Degrees of pain, morphine requirements, doses delivered and demanded, oral intake of food, and antiemetics given were used as endpoints. Acceptable pain (mean [SD]) was estimated to be 3.8 (1.3) on the NRS, and additional treatment was considered necessary at scores of 4.3 (1.6) or more. NRS at rest was 2.7 (2.2) and during mobilization 4.7 (2.6). Required mean morphine per day was 81 (15) mg, and the number of doses requested increased during the first 6 days after the burn. The authors found no correlation between dose of morphine required and any other variables. Background pain can be controlled adequately with a standard PCA protocol. During mobilization, the pain experienced was too intense, despite having the already high doses of morphine increased. The present protocol must be refined further to provide analgesia adequate to cover mobilization as well.

  • 9.
    Nilsson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Bokström, Pernilla
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Gårdman, Caroline
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Rutberg, Hans
    Östergötlands Läns Landsting, Patient Security.
    Systematic review of adverse events in a surgical ward2008Conference paper (Refereed)
  • 10.
    Nilsson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre.
    Lindberget, O
    Department of Anesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden.
    Gupta, Anil
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Vegfors, Magnus
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Implementing a pre-operative checklist to increase patient safety: a 1-year follow-up of personnel attitudes.2010In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 2, p. 176-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The operating room is a complex work environment with a high potential for adverse events. Protocols for perioperative verification processes have increasingly been recommended by professional organizations during the last few years. We assessed personnel attitudes to a pre-operative checklist ('time out') immediately before start of the operative procedure. METHODS: 'Time out' was implemented in December 2007 as an additional safety barrier in two Swedish hospitals. One year later, in order to assess how the checklist was perceived, a questionnaire was sent by e-mail to 704 persons in the operating departments, including surgeons, anesthesiologists, operation and anesthetic nurses and nurse assistants. In order to identify differences in response between professions, each alternative in the questionnaire was assigned a numerical value. RESULTS: The questionnaire was answered by 331 (47%) persons and 93% responded that 'time out' contributes to increased patient safety. Eighty-six percent thought that 'time out' gave an opportunity to identify and solve problems. Confirmation of patient identity, correct procedure, correct side and checking of allergies or contagious diseases were considered 'very important' by 78-84% of the responders. Attitudes to checking of patient positioning, allergies and review of potential critical moments were positive but differed significantly between the professions. Attitudes to a similar checklist at the end of surgery were positive and 72-99% agreed to the different elements. CONCLUSION: Staff attitudes toward a surgical checklist were mostly positive 1 year after their introduction in two large hospitals in central Sweden.

  • 11.
    Nilsson, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Pihl, A.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Tågsjö, M
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Adverse events are common on the intensive care unit: results from a structured record review2012In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 56, no 8, p. 959-965Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Intensive care is advanced and highly technical, and it is essential that, despite this, patient care remains safe and of high quality. Adverse events (AEs) are supposed to be reported to internal quality control systems by health-care providers, but many are never reported. Patients on the intensive care unit (ICU) are at special risk for AEs. Our aim was to identify the incidence and characteristics of AEs in patients who died on the ICUduring a 2-year period.

    METHODS:

    A structured record review according to the Global Trigger Tool (GTT) was used to review charts from patients cared for at the ICU of a middle-sized Swedish hospital during 2007 and 2008 and who died during or immediately after ICU care. All identified AEs were scored according to severity and preventability.

    RESULTS:

    We reviewed 128 records, and 41 different AEs were identified in 25 patients (19.5%). Health care-associated infections, hypoglycaemia, pressure sores and procedural complications were the most common harmful events. Twenty two (54%) of the AEs were classified as being avoidable. Two of the 41AEs were reported as complications according to the Swedish Intensive Care Registry, and one AE had been reported in the internal AE-reporting system.

    CONCLUSION:

    Almost one fifth of the patients who died on the ICU were subjected to harmful events. GTT has the advantage of identifying more patient injuries caused by AEs than the traditional AE-reporting systems used on many ICUs.

  • 12.
    Nyman, Erika
    et al.
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Burn Center.
    Huss, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Nyman, Torbjörn
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Junker, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Kratz, Gunnar
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hyaluronic acid, an important factor in the wound healing properties of amniotic fluid: In vitro studies of re-epithelialisation in human skin wounds2013In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 47, no 2, p. 89-92Article in journal (Refereed)
    Abstract [en]

    Foetal wounds are unique in their ability to heal rapidly without forming scars. The amniotic fluid, rich in nutrients, growth factors, and hyaluronic acid, surrounds the foetus and is essential to foetal wound healing. The wound healing properties of foetal wounds may be the result of high concentrations of hyaluronic acid. This study aimed to verify that amniotic fluid induces re-epithelialisation in human skin wounds in vitro and to study whether this ability is dependent on hyaluronic acid. Standard deep dermal wounds were produced in vitro in human skin. The skin samples, with a central wound, were incubated in different culture media. Varying concentrations of amniotic fluid and amniotic fluid with added hyaluronidase were tested, and re-epithelialisation was assessed at 3, 7, and 12 days using light microscopy, after staining with haematoxylin and eosin. Amniotic fluid 50% resulted in a significantly higher (p andlt; 0.05) grade of re-epithelialisation than Dulbeccos modified Eagles medium and 10% amniotic fluid at all time points. When 50% amniotic fluid was compared with 10% foetal calf serum, no significant difference was found in grades of re-epithelialisation on days 3 and 12 and significantly higher grades of re-epithelialisation on day 7 (p andlt; 0.05). Degradation of hyaluronic acid in the medium that contained 50% amniotic fluid gave significantly impaired re-epithelialisation (p andlt; 0.05) on culture days 3 and 7. In conclusion, amniotic fluid promotes accelerated re-epithelialisation and hyaluronic acid is an important ingredient.

  • 13.
    Orwelius, Lotti
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Bergkvist, Max
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Nordlund, Anders
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Simonsson, Eva
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping, Sweden.
    Nordlund, Peter
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping, Sweden.
    Bäckman, Carl
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
    Physical effects of trauma and the psychological consequences of preexisting diseases account for a significant portion of the health-related quality of life patterns of former trauma patients2012In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 72, no 2, p. 504-512Article in journal (Refereed)
    Abstract [en]

    Background: Health-related quality of life (HRQoL) is known to be significantly affected in former trauma patients. However, the underlying factors that lead to this outcome are largely unknown. In former intensive care unit (ICU) patients, it has been recognized that preexisting disease is the most important factor for the long-term HRQoL. The aim of this study was to investigate HRQoL up to 2 years after trauma and to examine the contribution of the trauma-specific, ICU-related, sociodemographic factors together with the effects of preexisting disease, and further to make a comparison with a large general population.

    Methods: A prospective 2-year multicenter study in Sweden of 108 injured patients. By mailed questionnaires, HRQoL was assessed at 6 months, 12 months, and 24 months after the stay in ICU by Short Form (SF)-36, and information of preexisting disease was collected from the national hospital database. ICU-related factors were obtained from the local ICU database. Comorbidity and HRQoL (SF-36) was also examined in the reference group, a random sample of 10,000 inhabitants in the uptake area of the hospitals.

    Results: For the trauma patients, there was a marked and early decrease in the physical dimensions of the SF-36 (role limitations due to physical problems and bodily pain). This decrease improved rapidly and was almost normalized after 24 months. In parallel, there were extensive decreases in the psychologic dimensions (vitality, social functioning, role limitations due to emotional problems, and mental health) of the SF-36 when comparisons were made with the general reference population.

    Conclusions: The new and important finding in this study is that the trauma population seems to have a trauma-specific HRQoL outcome pattern. First, there is a large and significant decrease in the physical dimensions of the SF-36, which is due to musculoskeletal effects and pain secondary to the trauma. This normalizes within 2 years, whereas the overall decrease in HRQoL remains and most importantly it is seen mainly in the psychologic dimensions and it is due to preexisting diseases

  • 14.
    Oscarsson Tibblin, Anna
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Perioperative myocardial damage and cardiac outcome in patients-at-risk undergoing non-cardiac surgery2010In: ACTA ANAESTHESIOLOGICA SCANDINAVICA, ISSN 0001-5172, Vol. 54, no 5, p. 656-657Article in journal (Refereed)
    Abstract [en]

    n/a

  • 15.
    Oscarsson Tibblin, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Gupta, Anil
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Järhult, Johannes
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nyström, Matti
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Pettersson, Eva
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Darvish, Bijan
    Department of Anaesthesia & Intensive Care University Hospital, Örebro, Sweden.
    Krook, Helena
    Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eintrei, Christina
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
    To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial2010In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 104, no 3, p. 305-312Article in journal (Refereed)
    Abstract [en]

    Background: Major adverse cardiac events (MACEs) are a common cause of deathafter non-cardiac surgery. Despite evidence for the benefitof aspirin for secondary prevention, it is often discontinuedin the perioperative period due to the risk of bleeding.

    Methods: We conducted a randomized, double-blind, placebo-controlledtrial in order to compare the effect of low-dose aspirin withthat of placebo on myocardial damage, cardiovascular, and bleedingcomplications in high-risk patients undergoing non-cardiac surgery.Aspirin (75 mg) or placebo was given 7 days before surgery andcontinued until the third postoperative day. Patients were followedup for 30 days after surgery.

    Results: A total of 220 patients were enrolled, 109 patients receivedaspirin and 111 received placebo. Four patients (3.7%) in theaspirin group and 10 patients (9.0%) in the placebo group hadelevated troponin T levels in the postoperative period (P=0.10).Twelve patients (5.4%) had an MACE during the first 30 postoperativedays. Two of these patients (1.8%) were in the aspirin groupand 10 patients (9.0%) were in the placebo group (P=0.02). Treatmentwith aspirin resulted in a 7.2% absolute risk reduction [95%confidence interval (CI), 1.3–13%] for postoperative MACE.The relative risk reduction was 80% (95% CI, 9.2–95%).Numbers needed to treat were 14 (95% CI, 7.6–78). No significantdifferences in bleeding complications were seen between thetwo groups.

    Conclusions: In high-risk patients undergoing non-cardiac surgery, perioperativeaspirin reduced the risk of MACE without increasing bleedingcomplications. However, the study was not powered to evaluatebleeding complications.

     

  • 16.
    Reini, Kirsi
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiothoracic Anaesthesia and Intensive care. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Oscarsson Tibblin, Anna
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    The prognostic value of the Modified Early Warning Score in critically ill patients: a prospective, observational study2012In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 29, no 3, p. 152-157Article in journal (Refereed)
    Abstract [en]

    Context The Modified Early Warning Score is a validated assessment tool for detecting risk of deterioration in patients at risk on medical and surgical wards. less thanbrgreater than less thanbrgreater thanObjective To assess the prognostic ability of the Modified Early Warning Score in predicting outcome after critical care. less thanbrgreater than less thanbrgreater thanDesign A prospective observational study. less thanbrgreater than less thanbrgreater thanSetting A tertiary care general ICU. less thanbrgreater than less thanbrgreater thanPatients Five hundred and eighteen patients aged at least 16 years admitted to the ICU at Linkoping University Hospital were included. less thanbrgreater than less thanbrgreater thanIntervention The Modified Early Warning Score was documented on arrival at the ICU and every hour for as long as the patient was breathing spontaneously, until discharge from the ICU. less thanbrgreater than less thanbrgreater thanMain outcome measures The primary endpoint was mortality in the ICU. Secondary endpoints were 30-day mortality, length of stay and readmission to the ICU. less thanbrgreater than less thanbrgreater thanResults Patients with a Modified Early Warning Score of at least six had significantly higher mortality in the ICU than those with a Modified Early Warning Score andlt;6 (24 vs. 3.4%, Pandlt; 0.001). A Modified Early Warning Score of at least six was an independent predictor of mortality in the ICU [odds ratio (OR) 5.5, 95% confidence interval (CI) 2.4-20.6]. The prognostic ability of the Modified Early Warning Score on admission to the ICU [area under the curve (AUC) 0.80, 95% CI 0.72-0.88] approached those of the Simplified Acute Physiology Score III (AUC 0.89, 95% CI 0.83-0.94) and the Sequential Organ Failure Assessment score on admission (AUC 0.91, 95% CI 0.86-0.97). A Modified Early Warning Score of at least six on admission was also an independent predictor of 30-day mortality (OR 4.3, 95% CI 2.3-8.1) and length of stay in the ICU (OR 2.3, 95% CI 1.4-3.8). In contrast, the Modified Early Warning Score on discharge from the ICU did not predict the need for readmission. less thanbrgreater than less thanbrgreater thanConclusion This study shows that the Modified Early Warning Score is a useful predictor of mortality in the ICU, 30-day mortality and length of stay in the ICU.

  • 17.
    Ylinenvaara, Sandra I
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Elisson, Olof
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Berg, Kim
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Zdolsek, Joachim H
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Krook, Helena
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Hahn, Robert G
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Research Unit, Södertälje Hospital, Södertälje, Sweden.
    Preoperative urine-specific gravity and the incidence of complications after hip fracture surgery: A prospective, observational study2014In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, no 2, p. 85-90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mild to moderately severe dehydration is common in the elderly, but its relationship to surgical outcome is unclear.

    OBJECTIVES: To study the incidence of dehydration prior to hip fracture surgery and its relationship to postoperative complications.

    DESIGN: Prospective observational study.

    SETTING: Operation department and orthopaedic ward at a regional hospital.

    PATIENTS: Forty-five patients [median (interquartile range) age 78 (75 to 86) years] undergoing acute hip fracture surgery.

    INTERVENTIONS: A urine sample was taken on admission to the operating theatre. Complications were assessed 2 days postoperatively using a check-list.

    MAIN OUTCOME MEASURES: Dehydration was considered to be present if the urinary specific gravity was 1.020 or higher, indicating renal water conservation. The number and type of postoperative complications were recorded.

    RESULTS: Dehydration was present in one third of the patients. Sixty percent of these patients had at least one postoperative complication, whereas the corresponding proportion was 30% in the euhydrated patients (P <0.01). Only one patient (3%) had more than one complication in the euhydrated group compared with six patients (40%) in the dehydrated group (P <0.01). Euhydrated patients had a mean of 0.3 postoperative complications per surgery, whereas dehydrated patients scored 1.1 complications (P <0.015). The higher incidence included confusion, arterial desaturation and cardiovascular events.

    CONCLUSION: Dehydration before surgery nearly quadrupled the number of postoperative complications after hip fracture repair.

     

  • 18.
    Zdolsek, Joachim
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Intensive Care UHL.
    Vegfors, Magnus
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Chemistry.
    Tornquist, T.
    Regional Hospital Motala.
    Bortnik, P.
    Regional Hospital Motala.
    Hahn, Robert
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Hydroxyethyl starches and dextran during hip replacement surgery: effects on blood volume and coagulation2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 6, p. 677-685Article in journal (Refereed)
    Abstract [en]

    Background: Colloid fluids influence the coagulation system by diluting the plasma and, potentially, by exerting other effects that are unique for each fluid product. We hypothesised that changes in the coagulation measured at the end of surgery would be mainly governed by differences in half-life between the colloid fluids. Methods: Eighty-four patients were randomised to receive one of four colloids: HES 130/0.42/6 : 1 (Venofundin (R)), 130/0.4/9 : 1 (Voluven (R)), 200/0.5/5 : 1 (Haes-steril (R)) and 6% dextran 70 (Macrodex (R)). Blood samples were taken just before and after a preoperative 500ml bolus, and also after subsequent elective hip replacement surgery. Volume expansion was estimated from the blood dilution and coagulation assessed by ROTEM, activated partial thromboplastin time, prothrombin international normalised ratio (PT-INR), D-dimer and thrombin-antithrombin complex (TAT). Results: The blood volume expansion amounted to approximately 600 ml for all four colloids directly after infusion. Voluven (R) and Haes-steril (R) prolonged the aPT time and Venofundin (R) increased TAT. Although all colloids increased PT-INR and D-dimer, the ROTEM analyses showed that they consistently shortened the clotting time and weakened the clot strength. These effects were mainly unchanged after surgery, during which the haemorrhage averaged 500-600 ml. Macrodex (R) produced a stronger volume support at the end of the surgery (91% of infused volume; Pless than0.001) than the three starch solutions (42-60%). Conclusions: All tested colloid fluids induced a mild hypercoagulable state with faster clotting, but with weaker clot strength. The additive influence of surgery was relatively small, and postoperative changes in coagulation were mainly due to differences in the half-life of each colloid.

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