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  • 1.
    Ahlberg, Mona
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Family functioning of families experiencing intensive care and the specific impact of the COVID-19 pandemic: A grounded theory study2023In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 76, article id 103397Article in journal (Refereed)
    Abstract [en]

    Objectives: In order to provide a deeper understanding of family functioning, the aim of this study was to identify, describe and conceptualise the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit, with the impact of a pandemic.Research methodology/design: The study has a grounded theory design including interviews with eight families.Setting: Former adult intensive care patients cared for Covid-19 infection and their family. Eight patients and twelve family members from three different intensive care units.Main outcome measures: The results presented are grounded in data and identified in the core category "Existential issues" and the categories "Value considerateness; Anxiety and insecurity in life; Insight into the unpredictability of life." Findings: The core category could be found in all data and its relationship and impact on the categories and each other. The core is a theoretical construction, whereas the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit was identified, described, and conceptualised. Being able to talk repeatedly about existential issues and the anxiety and insecurity in life, with people that have similar experiences helps the patient and their family to consider and gain insight into the unpredictability of life, and thereby better cope with changes in life.Conclusion: There is awareness about the love that exists within the family. A willing to supporting each other in the family even if the critical illness made the family anxious and afraid. Implications for clinical practice: Even if the pandemic Covid-19 led to restrictions inhibiting family focused nursing, it is important to confirm the family as a part of the caring of the ICU patient. The patients are not alone, their family are fighting together for the future.

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  • 2.
    Ahlberg, Mona
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Hollman Frisman, Gunilla
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Family Health Conversations create awareness of family functioning.2020In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, no 2, p. 102-108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The whole family is affected if one family member is critically ill. The Family Health Conversation Intervention may give the family tools that support healthier family functioning.

    AIMS AND OBJECTIVES: The aim of this study was to identify which components of family function are affected when families participate in Family Health Conversations.

    DESIGN: A secondary analysis was performed of existing qualitative interviews. The Family Health Conversation is an intervention where nurses ask the family reflective questions, and reflection is made possible in three conversation sessions.

    METHODS: This study included transcribed data from 13 follow-up interviews from seven families attending Family Health Conversations after three and 12 months. Data were analysed with narrative analysis, focusing on family function.

    RESULTS: Three themes were identified. The families' family functioning had been supported with: improved understanding of each other-there was an understanding of being in the same situation but still having totally different experiences; more concern for each other-they talked about their different experiences and felt they had become closer to each other; and a process of working through-they had experienced working through various experiences, standing by and supporting, and then being able to move on.

    CONCLUSIONS: The Family Health Conversation Intervention is provided to families, accompanied by nurses. The families in this study gained an awareness of their family function that brought the family closer because of improved understanding of each other and the situation. The families experienced openness, and the family members spoke more freely with each other, which facilitated the progress of working through the experience of critical illness and helped to maintain healthy family functioning.

    RELEVANCE TO CLINICAL PRACTICE: It is important to have an overall perspective and to recognize the patient and the family as equally important within the family for awareness of family function.

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  • 3.
    Ahlberg, Mona
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Persson, Carina
    Linnaeus Univ, Sweden.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Exploring family functioning and - hardiness in families experiencing adult intensive care - A cross-sectional study2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 7Article in journal (Refereed)
    Abstract [en]

    Being cared for in an intensive care unit affects both the patient being cared for and the family in various ways. The family is of great importance for the recovery of the former intensive-care patient. The aim is to explore family functioning and family hardiness in families of former intensive care patients. A cross-sectional study using two self-reported questionnaires. Former adult intensive care patients and their family were recruited to participate between December 2017 and June 2019. The data were coded and entered the Statistical Package for the Social Sciences version 25, for analysis. To explore questionnaire data, descriptive and inferential statistical analyses were performed. Scale values were calculated on, both family wise and between the patients and the family members. STROBE checklist was used. Data was collected from 60 families (60 former intensive cared patients and 85 family members) and showed that 50 families scored healthy family functioning and 52 high strengths in hardiness. The data showed small variations between and within families for family functioning and family hardiness, there were only two families scoring low for both family functioning and hardiness. The variation was higher within the families, but there was no significance level.The conclusions were that family functioning and hardiness was, to a large extent, assessed as good by the families. Nevertheless, it is important to help the family obtain information and support. So, the family need to continue to communicate, finding coping abilities and strengths in adopting new strategies to protect the family unit. The family are very important for members mental and physical recovery as the health of one family member affects the family as a unit.

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  • 4.
    Ahlberg, Mona
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Persson, Carina
    Linnaeus Univ, Sweden.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Family Health Conversations Versus Support Group Conversations When a Family Member Has Been Critically Ill: A Mixed Methods Study2021In: Families, Systems & Health, ISSN 1091-7527, E-ISSN 1939-0602, Vol. 39, no 2, p. 293-305Article in journal (Refereed)
    Abstract [en]

    Introduction: When a family member has been critically ill and cared for at an intensive care unit the individual family member as well as the family system are affected and in need of support. The aim of this study was to compare and contrast the responses from 2 different types of follow-up interventions for families of critically ill persons, focusing on individual hopes, health-related quality of life, family functioning and ability to cope with challenges. Method: Adult family members from 3 hospitals attended 1 of 2 interventions 2 months after intensive care. The family health conversation included the family. The support group conversation included just family members and not the patient who had experienced intensive care. Data were collected via self-reported questionnaires and follow-up interviews with family members. Quantitative and qualitative data were first analyzed separately, and the results were then integrated through mixed methods analysis. Results: A total of 38 family members took part in the interventions. Family members in the 2 intervention groups talked about how they had more hope for the future, and about how talking within the family and the group had helped them justify their feelings, which empowered them in the transition toward a healthier quality of life. Comparisons of the interventions show a higher significance of family function and hope in the family health conversation. Discussion: The article illustrates a disparity between how family members function and the needs they have for follow-up. We discuss what kind of follow-up these persons need.

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  • 5.
    Arestedt, Liselott
    et al.
    Linnaeus Univ, Sweden.
    Martinsson, Caroline
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Hjelm, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Uhlin, Fredrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Nephrology.
    Eldh, Ann Catrine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Context Factors Facilitating and Hindering Patient Participation in Dialysis Care: A Focus Group Study With Patients and Staff2020In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 17, no 6, p. 457-464Article in journal (Refereed)
    Abstract [en]

    Background Safe health care of good quality depends on structured and unceasing efforts to progress, promoting strategies tailored to the context, including elements such as patients preferences. Although patient participation is a common concept in health care, there is yet limited understanding of the factors that facilitate and hinder it in a healthcare context. Aims This paper identifies what patients and health professionals depict in terms of enablers and barriers for patient participation in dialysis care. Methods An explorative qualitative design was applied with seven focus group discussions with patients, staff, and managers across different types of hospitals, with the texts analyzed with content analysis. Results The dialysis context represents three key elements-people, resources, and interactions-that can both enable and hinder patient participation. Both barriers and facilitators for patient participation were found to reside at individual, team, and organizational levels, with a greater number of enabling factors implied by both patients and staff. Linking Evidence to Action While the dialysis context comprises opportunities for progress in favor of patient participation, a shared understanding of the concept is needed, along with how contextual factors can facilitate conditions for participation by patient preferences. In addition, the most favorable strategy for implementing person-centered care is not yet known, but to facilitate patient participation from a patient perspective, creating opportunities to enable staff and patients to share a common understanding is needed, along with tools to facilitate a dialogue on patient participation.

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  • 6.
    Boano, Gabriella
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Åström, Meriam
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Effect of cryothermic and radiofrequency Cox-Maze IV ablation on atrial size and function assessed by 2D and 3D echocardiography, a randomized trial. To freeze or to burn2023In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, no 6, p. 431-440Article in journal (Refereed)
    Abstract [en]

    BackgroundAtrial linear scars in Cox-Maze IV procedures are achieved using Cryothermy (Cryo) or radiofrequency (RF) techniques. The subsequent postoperative left atrial (LA) reverse remodelling is unclear. We used 2- and 3-dimensional echocardiography (2-3DE) to compare the impact of Cryo and RF procedures on LA size and function 1 year after Cox-maze IV ablation concomitant with Mitral valve (MV) surgery. MethodsSeventy-two patients with MV disease and AF were randomized to Cryo (n = 35) or RF (n = 37) ablation. Another 33 patients were enroled without ablation (NoMaze). All patients underwent an echocardiogram the day before and 1 year after surgery. The LA function was assessed on 2D strain by speckle tracking and 3DE. ResultsForty-two ablated patients recovered sinus rhythm (SR) 1 year after surgery. They had comparable left and right systolic ventricular function, LA volume index (LAVI), and 2D reservoir strain before surgery. At follow-up, the 3DE extracted reservoir and booster function were higher after RF (37 & PLUSMN; 10% vs. 26 & PLUSMN; 6%; p < 0.001) than Cryo ablation (18 & PLUSMN; 9 vs. 7 & PLUSMN; 4%; p < 0.001), while passive conduit function was comparable between groups (24 & PLUSMN; 11 vs. 20 & PLUSMN; 8%; p = 0.17). The extent of LAVI reduction depended on the duration of AF preoperatively. ConclusionsSR restoration after MV surgery and maze results in LA size reduction irrespective of the energy source used. Compared to RF, the extension of ablation area produced by Cryo implies a structural LA remodelling affecting LA systolic function.

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  • 7.
    Boano, Gabriella
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Åström Aneq, Meriam
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Spyrou, Giannis
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry. Linköping University, Faculty of Medicine and Health Sciences.
    Enocsson, Helena
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.
    Charitakis, Emmanouil
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Vánky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial2020In: Translational Medicine Communications, ISSN 2396-832X, Vol. 5, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Surgical cryothermia and radiofrequency (RF) ablations for atrial fibrillation (AF) seem to result in similar sinus rhythm restoration, but the biochemical consequences of the two methods are unclear. We aimed to compare the biochemical responses to the two ablative methods in concomitant mitral valve surgery (MVS).

    Methods: Sixty mitral valve surgery patients with AF were prospectively included. Forty-one patients planned for ablation were randomized to cryothermia (n = 20) or radiofrequency (n = 21) ablation and 19 served as controls. Markers for myocardial injury, inflammation, cell stress, apoptosis, and heart failure were analyzed pre- and postoperatively at different time points.

    Results: Troponin T and creatine kinase isoenzyme MB (CK-MB) peak levels were significantly higher in the cryothermia group compared with the RF group (12,805 [6140–15,700] vs. 2790 [1880–4180] ng/L; P = 0.002 and 271 [217–357] vs. 79 [66–93] μg/L; P < 0.001, respectively). Both groups had significantly higher levels than the no-ablation group. There were no group differences in C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there were correlations between pre- and postoperative levels of both CRP (rs = 0.41, P = 0.001) and NT-proBNP (rs = 0.48, P < 0.001). Protease-activated receptor 1 (PAR-1) and heat shock protein 27 (HSP27) were significantly increased in the cryoablation group.

    Conclusions: Cryoablation results in a larger myocardial injury and possibly more elevated apoptotic activity and cell stress compared with the RF technique. The type of ablation device did not have any significant influence on the postoperative inflammatory response nor on the early postoperative levels of NT-proBNP.

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  • 8.
    Brill, Jason B.
    et al.
    Univ Texas Hlth Sci Ctr Houston, TX 77030 USA.
    Brenner, Megan
    Univ Calif Riverside, CA 92521 USA.
    Duchesne, Juan
    Dept Surg Tulane, LA USA.
    Roberts, Derek
    Dept Surg Tulane, LA USA.
    Ferrada, Paula
    VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia.
    Horer, Tal
    Orebro Univ Hosp, Sweden; Univ Orebro, Sweden.
    Kauvar, David
    San Antonio Mil Med Ctr, TX USA.
    Khan, Mansoor
    Royal Ctr Def Med, England.
    Kirkpatrick, Andrew
    Univ Calgary, Canada; Foothills Med Ctr, Canada; Canadian Forces Hlth Serv, Canada.
    Ordonez, Carlos
    Univ Valle, Colombia.
    Perreira, Bruno
    Univ Estadual Campinas, Brazil.
    Pirouzram, Artai
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Cotton, Bryan A.
    Univ Texas Hlth Sci Ctr Houston, TX 77030 USA.
    The Role of TEG and ROTEM in Damage Control Resuscitation2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 52-61Article in journal (Refereed)
    Abstract [en]

    Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patients arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.

  • 9.
    Bruno, Raphael Romano
    et al.
    Heinrich Heine Univ Duesseldorf, Germany.
    Wernly, Bernhard
    Paracelsus Med Univ, Austria; Karolinska Univ Hosp, Sweden.
    Kelm, Malte
    Heinrich Heine Univ Duesseldorf, Germany; Cardiovasc Res Inst Dusseldorf, Germany.
    Boumendil, Ariane
    St Hop Paris, France.
    Morandi, Alessandro
    Dept Rehabil Hosp Ancelle Cremona, Italy; Geriatr Res Grp, Italy.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Artigas, Antonio
    CIBERes Corporac Sanitaria Univ Parc Tau, Spain.
    Finazzi, Stefano
    Ist Ric Farmacol Mario Negri IRCCS, Italy.
    Cecconi, Maurizio
    Humanitas Univ, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Denmark.
    Faraldi, Loredana
    Grande Osped Metropolitano Niguarda, Italy.
    Lichtenauer, Michael
    Paracelsus Med Univ, Austria.
    Muessig, Johanna M.
    Heinrich Heine Univ Duesseldorf, Germany.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Moreno, Rui
    Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    1K12 Ghent Univ Hosp, Belgium.
    ohman, Christina Agvald
    Karolinska Univ Hosp, Sweden.
    Pinto, Bernardo Bollen
    Geneva Univ Hospitals, Switzerland.
    Soliman, Ivo W.
    Univ Utrecht, Netherlands.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Austria.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Leaver, Susannah
    Res Lead Critical Care Directorate St Georges Hos, England.
    Boulanger, Carole
    Royal Devon & Exeter NHS Fdn Trust, England.
    Walther, Sten
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    ICU, Ukraine.
    Elhadi, Muhammed
    Alkhums Hosp, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    De Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Guidet, Bertrand
    St Hop Paris, France; Sorbonne Univ, France; INSERM, France.
    Flaatten, Hans
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Jung, Christian
    Heinrich Heine Univ Duesseldorf, Germany.
    Management and outcomes in critically ill nonagenarian versus octogenarian patients2021In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 576Article in journal (Refereed)
    Abstract [en]

    Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (&gt;= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p &lt; 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p &lt; 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p &lt; 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.

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  • 10.
    Bydén, Moa
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Segernäs Kvitting, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Thulesius, Hans
    Lund Univ, Sweden; Linnaeus Univ, Sweden.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Ahlgren, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Skoog, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Zachrisson, Helene
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Cerebrovascular Reserve Capacity as a Predictor of Postoperative Delirium: A Pilot Study2021In: Frontiers in Surgery, E-ISSN 2296-875X, Vol. 8, article id 658849Article in journal (Refereed)
    Abstract [en]

    Introduction: Postoperative delirium is a common complication after cardiac surgery with cardiopulmonary bypass (CPB). Compromised regulation of the cerebral circulation may be a predisposing factor for delirium. However, the potential relationship between cerebrovascular reserve capacity and delirium is unknown. The aim of this study was to investigate if impaired cerebrovascular reserve capacity was associated with postoperative delirium.Methods: Forty-two patients scheduled for cardiac surgery with CPB were recruited consecutively. All patients underwent preoperative transcranial Doppler (TCD) ultrasound with calculation of breath-hold index (BHI). BHI &lt; 0.69 indicated impaired cerebrovascular reserve capacity. In addition, patients were examined with preoperative neuropsychological tests such as MMSE (Mini Mental State Examination) and AQT (A Quick Test of cognitive speed). Postoperative delirium was assessed using Nursing Delirium Screening Scale (Nu-DESC) in which a score of &gt;= 2 was considered as delirium.Results: Six patients (14%) scored high for postoperative delirium and all demonstrated impaired preoperative cerebrovascular reserve capacity. Median (25th-75th percentile) BHI in patients with postoperative delirium was significantly lower compared to the non-delirium group [0.26 (-0.08-0.44) vs. 0.83 (0.57-1.08), p = 0.002]. Preoperative MMSE score was lower in patients who developed postoperative delirium (median, 25th-75th percentile; 26.5, 24-28 vs. 28.5, 27-29, p = 0.024). Similarly, patients with postoperative delirium also displayed a slower performance during the preoperative cognitive speed test AQT color and form (mean +/- SD; 85.8 s +/- 19.3 vs. 69.6 s +/- 15.8, p = 0.043).Conclusion: The present findings suggest that an extended preoperative ultrasound protocol with TCD evaluation of cerebrovascular reserve capacity and neuropsychological tests may be valuable in identifying patients with increased risk of developing delirium after cardiac surgery.

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  • 11.
    Chew, Michelle
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Johansson Blixt, Patrik
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Åhman, Rasmus
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Engerström, Lars
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Andersson, Henrik
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Berggren, Ritva Kiiski
    Umea Univ Hosp, Sweden.
    Tegnell, Anders
    Department of Public Health Reporting, Public Health Agency of Sweden, Sweden.
    Mcintyre, Sarah
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    National outcomes and characteristics of patients admitted to Swedish intensive care units for COVID-19 A registry-based cohort study2021In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 38, no 4, p. 335-343Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission. OBJECTIVE To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19. DESIGN Registry-based cohort study with prospective data collection. SETTING Admissions to Swedish ICUs from 6 March to 6 May 2020 with laboratory confirmed COVID-19 disease. PARTICIPANTS Adult patients admitted to Swedish ICUs. EXPOSURES Baseline characteristics, intensive care treatments and organ failures. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and death. RESULTS We identified 1563 patients with complete 30-day follow-up. The 30-day all-cause mortality was 26.7%. Median age was 61 [52 to 69], Simplified Acute Physiology Score III (SAPS III) was 53 [46 to 59] and 62.5% had at least one comorbidity. Median PaO2/FiO(2) on admission was 97.5 [75.0 to 140.6] mmHg, 74.7% suffered from moderate-to-severe acute respiratory failure. Age, male sex [adjusted odds ratio (aOR) 1.5 (1.1 to 2.2)], SAPS III score [aOR 1.3 (1.2 to 1.4)], severe respiratory failure [aOR 3.0 (2.0 to 4.7)], specific COVID-19 pharmacotherapy [aOR 1.4 (1.0 to 1.9)] and continuous renal replacement therapy [aOR 2.1 (1.5 to 3.0)] were associated with increased mortality. Except for chronic lung disease, the presence of comorbidities was not independently associated with mortality. CONCLUSIONS Thirty-day mortality rate in COVID-19 patients admitted to Swedish ICUs is generally lower than previously reported despite a severe degree of hypoxaemia on admission. Mortality was driven by age, baseline disease severity, the presence and degree of organ failure, rather than pre-existing comorbidities.

  • 12.
    Chew, Michelle
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Kattainen, Salla
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Haase, Nicolai
    Copenhagen Univ Hosp, Denmark.
    Buanes, Eirik A.
    Helse Bergen Hlth Trust, Norway.
    Kristinsdottir, Linda B.
    Landspitali Natl Univ Hosp Iceland, Iceland.
    Hofso, Kristin
    Oslo Univ Hosp, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Laake, Jon Henrik
    Oslo Univ Hosp, Norway; Oslo Univ Hosp, Norway.
    Kvale, Reidar
    Helse Bergen HF, Norway; Haukeland Hosp, Norway.
    Hastbacka, Johanna
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Reinikainen, Matti
    Univ Eastern Finland, Finland; Kuopio Univ Hosp, Finland.
    Bendel, Stepani
    Univ Eastern Finland, Finland; Kuopio Univ Hosp, Finland.
    Varpula, Tero
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Walther, Sten
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Health, Medicine and Caring Sciences. Varmland Cty Council, Sweden.
    Perner, Anders
    Copenhagen Univ Hosp, Denmark.
    Flaatten, Hans K.
    Helse Bergen HF, Norway; Haukeland Hosp, Norway.
    Sigurdsson, Martin I
    Landspitali Natl Univ Hosp Iceland, Iceland; Univ Iceland, Iceland.
    A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries2022In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 66, no 1, p. 56-64Article in journal (Refereed)
    Abstract [en]

    Background We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID-19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID-19 disease during the first wave of COVID-19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS-CoV-2, the ratio of requiring ICU admission for COVID-19 varied substantially (1.6%-6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID-19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%-85%) in all countries, the proportion of patients receiving renal replacement therapy (7%-26%) and various experimental therapies for COVID-19 disease varied substantially (e.g. use of hydroxychloroquine 0%-85%). Crude ICU mortality ranged from 11% to 33%. Conclusion There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID-19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.

  • 13.
    Dagnegård, H.H.
    et al.
    Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
    Bekke, K.
    Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
    Kolseth, S.M.
    Department of Heart Disease, Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Glaser, N.
    Department of Cardiology, Södersjukhuset, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Wallén, C.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    El-Hamamsy, I.
    Montreal Heart Institute, University of Montreal, Montreal, QC, Canada.
    Vidisson, K.O.
    Department of Cardiothoracic Surgery, Landspítali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Lie, A.S.
    Department of Heart Disease, Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Valentin, J.B.
    Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
    Sartipy, U.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Haaverstad, R.
    Department of Heart Disease, Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Lefebvre, L.
    Montreal Heart Institute, University of Montreal, Montreal, QC, Canada.
    Gudbjartsson, T.
    Department of Cardiothoracic Surgery, Landspítali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Johnsen, S.P.
    Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
    Søndergaard, L.
    Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
    Thyregod, G.H.
    Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
    Lund, J.T.
    Cardio Thoracic Surgical Department, Green Lane Division, Auckland City Hospital, Auckland, New Zealand.
    Ihlemann, N.
    Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
    Smerup, M.H.
    Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
    Survival after aortic root replacement with a stentless xenograft is determined by patient characteristics2022In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 164, no 6, p. 1712-1724Article in journal (Refereed)
    Abstract [en]

    Objectives: Our objective was to examine intermediate-term survival and reinterventions in unselected patients, stratified according to indication, who received a Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis as a full aortic root replacement. Methods: Data from medical records were retrospectively collected for patients who had aortic root replacement using Freestyle bioprostheses between 1999 and 2018 at 6 North-Atlantic centers. Survival status was extracted from national registries and results stratified according to indication for surgery. Results: We included 1030 implantations in 1008 patients with elective indications for surgery: aneurysm (39.8%), small root (8.3%), and other (13.8%), and urgent/emergent indications: endocarditis (26.7%) and Stanford type A aortic dissection (11.4%). Across indications, 46.3% were nonelective cases and 34.0% were reoperations. Median age was 66.0 (interquartile range, 58.0-71.8) years and median follow-up was 5.0 (interquartile range, 2.6-7.9) years. Thirty-day mortality varied from 2.9% to 27.4% depending on indication. Intermediate survival for 90-day survivors with elective indications were not different from the general population standardized for age and sex (P = .95, 83, and .16 for aneurysms, small roots, and other, respectively). In contrast, patients with endocarditis and type A dissection had excess mortality (P &lt; .001). Freedom from valve reinterventions was 95.0% and 94.4% at 5 and 8 years, respectively. In all, 52 patients (5.2%) underwent reinterventions, most because of endocarditis. Conclusions: At intermediate term follow-up this retrospective study provides further support for the use of the Freestyle bioprosthesis in the real-world setting of diverse, complex, and often high-risk aortic root replacement and suggests that outcome is determined by patient and disease, rather than by prosthesis, characteristics. © 2021 The Authors

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  • 14.
    de Cort, Boris A.
    et al.
    Isala, Netherlands.
    Salemans, Pieter B.
    Isala, Netherlands; Zuyderland Med Ctr, Netherlands.
    Fritschy, Wilbert M.
    Isala, Netherlands.
    Pierie, Maurice E. N.
    Isala, Netherlands.
    Lind, Robert C.
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Isala, Netherlands.
    Long-Term Outcome for Covered Endovascular Reconstruction of Aortic Bifurcation for Aortoiliac Disease: A Single-Center Experience2021In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 28, no 6, p. 906-913Article in journal (Refereed)
    Abstract [en]

    Purpose The gold standard for the treatment of complex (TASC II C and D) atherosclerotic aortoiliac lesions is still open surgical repair. Endovascular techniques have a lower mortality and morbidity rate but this comes at the cost of worse patency rates when compared with open repair. Improved short- and mid-term results have been reported using the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. The aim of this study was to report our initial experience with the CERAB technique and report long-term patency rates. Materials and Methods All patients treated with the CERAB technique between 2012 and 2018 were prospectively registered in an institutional database and included in this study. Patient demographics, characteristics, symptoms, procedural, and follow-up details were collected and analyzed retrospectively. Perioperative complications and reinterventions were also identified. The Kaplan-Meier survival method was used to assess cumulative rates of patency. Results A total of 44 patients were treated with the CERAB technique and included in this study. The majority of the treated aortoiliac occlusions were classified as complex: TASC II C (n=7; 15.9%) or TASC II D (n=25; 56.8%). Primary patency rate at 60 months was 83.3%, assisted primary patency was 90.9% and secondary patency 95%. No significant differences were found in patency rates comparing noncomplex (TASC II A and B) and complex (TASC II C and D) aortoiliac lesions. Seven patients (15.9%) required at least one additional procedure to maintain either assisted primary patency or secondary patency during follow-up. The 30-day complication rate in this series was 20.5% (n=9), of which 55.6% (n=5) were minor complications. All major 30-day complications (n=4) occurred during or directly after the CERAB procedure. Thirty-day mortality was 0%. No limb occlusions occurred within 30 days of the procedure. Conclusion Good long-term patency rates can be achieved with the CERAB technique to treat aortoiliac stenosis or occlusions while maintaining advantages associated with endovascular interventions. This remains true even when a CERAB is used to treat complex aortoiliac lesions. An endo-first approach to treat complex aortoiliac lesions seems viable.

  • 15.
    Drakenberg, Anna
    et al.
    Orebro Univ, Sweden; Orebro Univ Hosp, Sweden.
    Arvidsson-Lindvall, MiaLinn
    Orebro Univ, Sweden.
    Ericsson, Elisabeth
    Orebro Univ, Sweden.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Sundqvist, Ann-Sofie
    Orebro Univ, Sweden.
    The symphony of open-heart surgical care: A mixed-methods study about interprofessional attitudes towards family involvement2023In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2176974Article in journal (Refereed)
    Abstract [en]

    Purpose The overall aim of this study was to describe the attitudes towards family involvement in care held by nurses and medical doctors working in open-heart surgical care and the factors influencing these attitudes. Methods Mixed-methods convergent parallel design. A web-based survey was completed by nurses (n = 267) using the Families Importance in Nursing Care-Nurses Attitudes (FINC-NA) instrument and two open-ended questions, generating one quantitative and one qualitative dataset. Qualitative interviews with medical doctors (n = 20) were conducted in parallel, generating another qualitative dataset. Data were analysed separately according to each paradigm and then merged into mixed-methods concepts. Meta-inferences of these concepts were discussed. Results The nurses reported positive attitudes in general. The two qualitative datasets from nurses and medical doctors resulted in the identification of seven generic categories. The main mixed-methods finding was the attitude that the importance of family involvement in care depends on the situation. Conclusions The dependence of family involvement on the situation may be due to the patients and familys unique needs. If professionals attitudes rather than the familys needs and preferences determine how the family is involved, care runs the risk of being unequal.

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  • 16.
    Engerström, Lars
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Freter, Wolfgang
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Sellgren, Johan
    Sahlgrenska University Hospital, Gothenburg, Sweden; Gothenburg University, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Region Östergötland, Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Faculty of Medicine and Health Sciences, Forum Östergötland.
    Walther, Sten M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Mortality Prediction After Cardiac Surgery: Higgins Intensive Care Unit Admission Score Revisited2020In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 110, no 5, p. 1589-1594Article in journal (Refereed)
    Abstract [en]

    Background. This study was performed to develop and validate a cardiac surgical intensive care risk adjustment model for mixed cardiac surgery based on a few preoperative laboratory tests, extracorporeal circulation time, and measurements at arrival to the intensive care unit. Methods. This was a retrospective study of admissions to 5 cardiac surgical intensive care units in Sweden that submitted data to the Swedish Intensive Care Registry. Admissions from 2008 to 2014 (n = 21,450) were used for model development, whereas admissions from 2015 to 2016 (n = 6463) were used for validation. Models were built using logistic regression with transformation of raw values or categorization into groups. Results. The final model showed good performance, with an area under the receiver operating characteristics curve of 0.86 (95% confidence interval, 0.83-0.89), a Cox calibration intercept of -0.16 (95% confidence interval, -0.47 to 0.19), and a slope of 1.01 (95% confidence interval, 0.89-1.13) in the validation cohort. Conclusions. Eleven variables available on admission to the intensive care unit can be used to predict 30-day mortality after cardiac surgery. The model performance was better than those of general intensive care risk adjustment models used in cardiac surgical intensive care and also avoided the subjective assessment of the cause of admission. The standardized mortality ratio improves over time in Swedish cardiac surgical intensive care. (C) 2020 by The Society of Thoracic Surgeons

  • 17.
    Engerström, Lars
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Swedish Intens Care Registry, Sweden.
    Thermaenius, Johan
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Mårtensson, Johan
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Oldner, Anders
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Petersson, Johan
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Kåhlin, Jessica
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Larsson, Emma
    Swedish Intens Care Registry, Sweden; Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Prevalence and impact of early prone position on 30-day mortality in mechanically ventilated patients with COVID-19: a nationwide cohort study2022In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 26, no 1, article id 264Article in journal (Refereed)
    Abstract [en]

    Background COVID-19 ARDS shares features with non-COVID ARDS but also demonstrates distinct physiological differences. Despite a lack of strong evidence, prone positioning has been advocated as a key therapy for COVID-19 ARDS. The effects of prone position in critically ill patients with COVID-19 are not fully understood, nor is the optimal time of initiation defined. In this nationwide cohort study, we aimed to investigate the association between early initiation of prone position and mortality in mechanically ventilated COVID-19 patients with low oxygenation on ICU admission. Methods Using the Swedish Intensive Care Registry (SIR), all Swedish ICU patients &gt;= 18 years of age with COVID-19 admitted between March 2020, and April 2021 were identified. A study-population of patients with PaO2/FiO(2) ratio &lt;= 20 kPa on ICU admission and receiving invasive mechanical ventilation within 24 h from ICU admission was generated. In this study-population, the association between early use of prone position (within 24 h from intubation) and 30-day mortality was estimated using univariate and multivariable logistic regression models. Results The total study cohort included 6350 ICU patients with COVID-19, of whom 46.4% were treated with prone position ventilation. Overall, 30-day mortality was 24.3%. In the study-population of 1714 patients with lower admission oxygenation (PaO2/FiO(2) ratio &lt;= 20 kPa), the utilization of early prone increased from 8.5% in March 2020 to 48.1% in April 2021. The crude 30-day mortality was 27.2% compared to 30.2% in patients not receiving early prone positioning. We found no significant association between early use of prone positioning and survival. Conclusions During the first three waves of the COVID-19 pandemic, almost half of the patients in Sweden were treated with prone position ventilation. We found no association between early use of prone positioning and survival in patients on mechanical ventilation with severe hypoxemia on ICU admission. To fully elucidate the effect and timing of prone position ventilation in critically ill patients with COVID-19 further studies are desirable.

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  • 18.
    Engström, Karolina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Vánky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Rehnberg, Malin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Trinks, Cecilia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Jonasson, Jon
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Green, Anna
    Orebro Univ, Sweden.
    Gunnarsson, Cecilia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Novel SMAD3 p.Arg386Thr genetic variant co-segregating with thoracic aortic aneurysm and dissection2020In: Molecular Genetics & Genomic Medicine, ISSN 2324-9269, Vol. 8, no 4, article id e1089Article in journal (Refereed)
    Abstract [en]

    Background Pathogenic variants in the SMAD3 gene affecting the TGF-beta/SMAD3 signaling pathway with aortic vessel involvement cause Loeys-Dietz syndrome 3, also known as aneurysms-osteoarthritis syndrome. Methods Description of clinical history of a family in Sweden using clinical data, DNA sequencing, bioinformatics, and pedigree analysis. Results We report a novel SMAD3 variant, initially classified as a genetic variant of uncertain clinical significance (VUS), and later found to be co-segregating with aortic dissection in the family. The index patient presented with a dissecting aneurysm of the aorta including the ascending, descending, and abdominal parts. Genotype analysis revealed a heterozygous missense SMAD3 variant: NM_005902.3(SMAD3): c.11576G amp;gt; C (p.Arg386Thr). The same variant was also identified in a 30 years old formalin-fixed paraffin-embedded block of tissue from a second cousin, who died at 26 years of age from a dissecting aneurysm of the aorta. Conclusion A "variant of uncertain significance" according to the ACMG guidelines has always a scope for reappraisal. Genetic counselling to relatives, and the offering of surveillance service is important to families with aortic aneurysm disease. The report also highlight the potential use of FFPE analysis from deceased relatives to help in the interpretation of variants.

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  • 19.
    Escobar Kvitting, John-Peder
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Natl Hosp Norway, Norway.
    Hermansson, Ulf
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Vanhanen, Ingemar
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Correction: Resection of a plasma cell granuloma combining a conventional posterolateral left-sided thoracotomy with a minimally invasive valve approach (vol 67, pg 894, 2019)2020In: General Thoracic and Cardiovascular Surgery, ISSN 1863-6705 , E-ISSN 1863-6713, Vol. 68, no 91Article in journal (Other academic)
    Abstract [en]

    n/a

  • 20.
    Flaatten, Hans
    et al.
    Univ Bergen, Norway.
    Guidet, Bertrand
    Sorbonne Univ, France.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Cecconi, Maurizio
    Humanitas Clin & Res Ctr IRCCS, Italy.
    Boumendil, Ariane
    Hop St Antoine, France.
    Elhadi, Muhammed
    Univ Tripoli, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Leaver, Susannah
    St George Hosp, England.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Nalapko, Yuriy
    ICU, Ukraine.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Walther, Sten M.
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Reliability of the Clinical Frailty Scale in very elderly ICU patients: a prospective European study2021In: Annals of Intensive Care, ISSN 2110-5820, E-ISSN 2110-5820, Vol. 11, no 1, article id 22Article in journal (Refereed)
    Abstract [en]

    Purpose Frailty is a valuable predictor for outcome in elderly ICU patients, and has been suggested to be used in various decision-making processes prior to and during an ICU admission. There are many instruments developed to assess frailty, but few of them can be used in emergency situations. In this setting the clinical frailty scale (CFS) is frequently used. The present study is a sub-study within a larger outcome study of elderly ICU patients in Europe (the VIP-2 study) in order to document the reliability of the CFS. Materials and methods From the VIP-2 study, 129 ICUs in 20 countries participated in this sub-study. The patients were acute admissions &gt;= 80 years of age and frailty was assessed at admission by two independent observers using the CFS. Information was obtained from the patient, if not feasible, from the family/caregivers or from hospital files. The profession of the rater and source of data were recorded along with the score. Interrater variability was calculated using linear weighted kappa analysis. Results 1923 pairs of assessors were included and background data of patients were similar to the whole cohort (n = 3920). We found a very high inter-rater agreement (weighted kappa 0.86), also in subgroup analyses. The agreement when comparing information from family or hospital records was better than using only direct patient information, and pairs of raters from same profession performed better than from different professions. Conclusions Overall, we documented a high reliability using CFS in this setting. This frailty score could be used more frequently in elderly ICU patients in order to create a more holistic and realistic impression of the patient s condition prior to ICU admission.

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  • 21.
    Flaatten, Hans
    et al.
    Haukeland Hosp, Norway.
    Guidet, Bertrand
    Sorbonne Univ, France.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Boumendil, Ariane
    Hop St Antoine, France.
    Leaver, Susannah
    St George Hosp, England.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Andersen, Finn
    Alesund Hosp, Norway.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Walther, Sten
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Elhadi, Muhammed
    Univ Tripili, Libya.
    Nalapko, Yuriy
    European Wellness Int, Ukraine.
    Fjolner, Jesper
    Viborg Reg Hosp, Denmark.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Consent is a confounding factor in a prospective observational study of critically ill elderly patients2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 10, article id e0276386Article in journal (Refereed)
    Abstract [en]

    During analysis of a prospective multinational observation study of critically ill patients &gt;= 80 years of age, the VIP2 study, we also studied the effects of differences in country consent for study inclusion. This is a post hoc analysis where the ICUs were analyzed according to requirement for study consent. Group A: ICUs in countries with no requirement for consent at admission but with deferred consent in survivors. Group B: ICUs where some form of active consent at admission was necessary either from the patient or surrogates. Patients characteristics, the severity of disease and outcome variables were compared. Totally 3098 patients were included from 21 countries. The median age was 84 years (IQR 81-87). England was not included because of changing criteria for consent during the study period. Group A (7 countries, 1200 patients), and group B (15 countries, 1898 patients) were comparable with age and gender distribution. Cognition was better preserved prior to admission in group B. Group A suffered from more organ dysfunction at admission compared to group B with Sequential Organ Failure Assessment score median 8 and 6 respectively. ICU survival was lower in group A, 66.2% compared to 78.4% in group B (p&lt;0.001). We hence found profound effects on outcomes according to differences in obtaining consent for this study. It seems that the most severely ill elderly patients were less often recruited to the study in group B. Hence the outcome measured as survival was higher in this group. We therefore conclude that consent likely is an important confounding factor for outcome evaluation in international studies focusing on old patients.

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  • 22.
    Forsberg, Gustaf
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Divanoglou, Anestis
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Levi, Richard
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Ekqvist, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Östholm Balkhed, Åse
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Niward, Katarina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Improved 60-day survival but impaired general health in Swedish ICU-COVID patients: An ambidirectional population-based study2022In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 66, no 5, p. 569-579Article in journal (Refereed)
    Abstract [en]

    Background Survival among critically ill COVID-19 patients varies between countries and time periods. Mortality rates up to 60% have been reported in intensive care units (ICUs). Standard-of-care has evolved throughout the pandemic. The purpose of the study was to explore management and mortality of COVID-19 ICU-patients during the first pandemic wave and assess their post-ICU health status. Methods We conducted an exploratory observational ambidirectional population-based study of ICU-patients with COVID-19 in a Swedish county during 1 March-30 June 2020. Primary outcome was 60-day mortality with secondary outcomes including treatments, complications, self-reported general health and dyspnoea post-discharge. Patients were consecutively divided into equal tertiles with cut-offs on April 4 and April 20, 2020, to analyse time trends. Results One hundred patients, median age was 63 years, were included, and 60-day mortality rate was 22%. Ninety-one percent had moderate/severe ARDS and 88% required mechanical ventilation. In the first tertile of patients 60-day mortality was 33%, declining to 15% and 18% in the following two. This reduction paralleled increased use of thromboprophylaxis, less steep rise of treated ICU-patients per day and expanded ICU resources. Four months post-discharge, 63% of survivors reported self-assessed decline in general health retrospectively compared to prior COVID-19. Conclusions In this cohort, the initial 60-day mortality quickly declined, despite continuous admittance of critically ill patients. This was parallel to adaptation to increased workload and more intense thromboembolic prophylaxis. A majority of survivors reported declined general health four months after discharge. Further studies on long-term health status of ICU-survivors are indicated.

  • 23.
    Forsberg, Gustaf
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Taxbro, Knut
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Ryhov Cty Hosp, Sweden.
    Elander, Louise
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Nykoping Hosp, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Idh, Jonna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Department of Anaesthesiology and Intensive Care, Västervik Hospital, Västervik, Sweden.
    Berkius, Johan
    Department of Anaesthesiology and Intensive Care, Västervik Hospital, Västervik, Sweden.
    Ekman, Andreas
    Kalmar Hosp, Sweden; Linnaeus Univ, Sweden.
    Hammarskjöld, Fredrik
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Niward, Katarina
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Östholm Balkhed, Åse
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Risk factors for ventilator-associated lower respiratory tract infection in COVID-19, a retrospective multicenter cohort study in Sweden2024In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 68, no 2, p. 226-235Article in journal (Refereed)
    Abstract [en]

    Background: Ventilator-associated lower respiratory tract infections (VA-LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA-LRTI have been reported among COVID-19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA-LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID-19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA-LTRI on morbidity and mortality.Methods: We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID-19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA-LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA-LRTI.Results: Of a total of 536 included patients, 153 (28.5%) developed VA-LRTI. Incidence rate of first VA-LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA-LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA-LRTI had fewer ventilator-free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds-ratio (aOR) for first VA-LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31-5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14-3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03-1.07]). Few multidrug-resistant pathogens were identified. Incidence of VA-LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves.Conclusion: We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI.

  • 24.
    Forssell, Claes
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Bjarnegård, Niclas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Nyström, Fredrik H.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    A Pilot Study of Perioperative External Circumferential Cryoablation of Human Renal Arteries for Sympathetic Denervation2020In: Vascular specialist international, ISSN 2288-7970, Vol. 36, no 3, p. 151-157Article in journal (Refereed)
    Abstract [en]

    Cryoablation, which induces cellular death without extensive tissue damage, has been extensively used to denervate the myocardium. However, periadventitial external circumferential application of cryotherapy to denervate the renal artery sympathetic nerves has, to our knowledge, never been tested in humans. The main aim of this study was to examine the safety and potential effects of cryotherapy on ambulatory blood pressure levels and other outcomes that are indirectly related to sympathetic tone, including pulse-wave velocity, central pulse pressure, and glucose levels.

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  • 25.
    Fronczek, Jakub
    et al.
    Jagiellonian Univ Med Coll, Poland.
    Flaatten, Hans
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Guidet, Bertrand
    UPMC Univ Paris 06, France; Hop St Antoine, France.
    Polok, Kamil
    Jagiellonian Univ Med Coll, Poland.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Andrew, Benjamin Y.
    Duke Univ, NC 27710 USA.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Beil, Michael
    Hadassah Med Ctr, Israel.
    Cecconi, Maurizio
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Denmark.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Gorka, Jacek
    Jagiellonian Univ Med Coll, Poland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Kusza, Krzysztof
    Poznan Univ Med Sci, Poland.
    Leaver, Susannah
    St George Hosp, England.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Morandi, Alessandro
    Geriatr Res Grp, Italy.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Owczuk, Radoslaw
    Med Univ Gdansk, Poland.
    Agvald-Ohman, Christina
    Karolinska Univ Hosp, Sweden.
    Pinto, Bernardo B.
    Geneva Univ Hosp, Switzerland.
    Rhodes, Andrew
    St Georges Univ Hosp NHS Fdn Trust, England.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Soliman, Ivo W.
    Univ Utrecht, Netherlands.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Austria.
    Walther, Sten
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Linköping University, Department of Health, Medicine and Caring Sciences.
    Watson, Ximena
    St Georges Univ Hosp NHS Fdn Trust, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Short-term mortality or patients >= 80 years old admitted to European intensive care units: an international observational study2022In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 129, no 1, p. 58-66Article in journal (Refereed)
    Abstract [en]

    Background: Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients. Methods: Multilevel analysis of two international prospective cohort studies. We included patients &gt;= 80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs). Results: Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97]). Conclusion: The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation.

  • 26.
    Fronczek, Jakub
    et al.
    Jagiellonian Univ Med Coll, Poland.
    Polok, Kamil
    Jagiellonian Univ Med Coll, Poland.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Beil, Michael
    Hadassah Med Ctr, Israel.
    Rhodes, Andrew
    St Georges Univ Hosp NHS Fdn Trust, England.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Gorka, Jacek
    Jagiellonian Univ Med Coll, Poland.
    Andersen, Finn H.
    Alesund Hosp, Norway; NITNU, Norway.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Cecconi, Maurizio
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Denmark.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Leaver, Susannah
    Crit Care Directorate St Georges Hosp, England.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Morandi, Alessandro
    Dept Rehabil Hosp Ancelle Cremona Italy, Italy.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Agvald-Ohman, Christina
    Karolinska Univ Hosp, Sweden.
    Pinto, Bernardo Bollen
    Geneva Univ Hosp, Switzerland.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Austria.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Watson, Ximena
    St Georges Univ Hosp NHS Fdn Trust, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    Sviri, Sigal
    Hebrew Univ Jerusalem, Israel; Hebrew Univ Jerusalem, Israel.
    van Heerden, Peter Vernon
    Hebrew Univ Jerusalem, Israel; Hebrew Univ Jerusalem, Israel.
    Flaatten, Hans
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Guidet, Bertrand
    UPMC Univ Paris 06, France.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Relationship between the Clinical Frailty Scale and short-term mortality in patients >= 80 years old acutely admitted to the ICU: a prospective cohort study2021In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 25, no 1, article id 231Article in journal (Refereed)
    Abstract [en]

    Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients &gt;= 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patients age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p &lt; 0.001). The relationship between the CFS score and mortality was nonlinear (p &lt; 0.01). Conclusion Knowledge about a patients frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

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  • 27.
    Gavali, Hamid
    et al.
    Uppsala Univ, Sweden.
    Mani, Kevin
    Uppsala Univ, Sweden.
    Furebring, Mia
    Uppsala Univ, Sweden.
    Olsson, Karl W.
    Uppsala Univ, Sweden.
    Lindstrom, David
    Uppsala Univ, Sweden; Karolinska Univ Hosp, Sweden.
    Sorelius, Karl
    Rigshosp, Denmark; Univ Copenhagen, Denmark.
    Sigvant, Birgitta
    Uppsala Univ, Sweden; Orebro Univ, Sweden.
    Gidlund, Khatereh D.
    Uppsala Univ, Sweden; Gavle Cty Hosp, Sweden.
    Torstensson, Gustav
    Helsingborg Reg Hosp, Sweden.
    Andersson, Manne
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Cty Hosp Ryhov, Sweden.
    Forssell, Claes
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Astrand, Hakan
    Cty Hosp Ryhov, Sweden.
    Lundstrom, Tobias
    Eskilstuna Hosp, Sweden.
    Khan, Shahzad
    Lund Univ, Sweden.
    Sonesson, Bjorn
    Lund Univ, Sweden.
    Stackelberg, Otto
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Gillgren, Peter
    Karolinska Inst, Sweden; Soder Sjukhuset, Sweden.
    Isaksson, Jon
    Umea Univ, Sweden.
    Kragsterman, Bjorn
    Uppsala Univ, Sweden; Vasteras Hosp, Sweden.
    Horer, Tal
    Orebro Univ, Sweden; Orebro Univ, Sweden.
    Sadeghi, Mitra
    Orebro Univ, Sweden; Orebro Univ, Sweden.
    Wanhainen, Anders
    Uppsala Univ, Sweden.
    Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study2021In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 62, no 6, p. 918-926Article in journal (Refereed)
    Abstract [en]

    Objective: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study. Methods: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 andMay 2017. The primary aimwas to compare short and long termsurvival, as well as complications for EAB and ISR. Results: Some 126 radically surgically treated AGI patients were identified - 102 graft infections and 24 endograft infections - treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p = .46), or long term five year survival (48.2% vs. 49.9%, p = .87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p = .56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age &gt;= 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 - 14.8), coronary artery disease (OR 4.2, CI 1.2 - 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 - 22.5) were associated with early death. Prolonged antimicrobial therapy (&gt; 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 - 0.9). Conclusion: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.

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  • 28.
    Gavali, Hamid
    et al.
    Uppsala Univ, Sweden.
    Mani, Kevin
    Uppsala Univ, Sweden.
    Furebring, Mia
    Uppsala Univ, Sweden.
    Olsson, Karl Wilhelm
    Uppsala Univ, Sweden.
    Lindstrom, David
    Uppsala Univ, Sweden.
    Sorelius, Karl
    Rigshospitalet, Denmark.
    Sigvant, Birgitta
    Uppsala Univ, Sweden; Karlstad Cent Hosp, Sweden.
    Torstensson, Gustav
    Helsingborg Hosp, Sweden.
    Andersson, Manne
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Cty Hosp Ryhov, Sweden.
    Forssell, Claes
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Astrand, Hakan
    Cty Hosp Ryhov, Sweden.
    Lundstrom, Tobias
    Eskilstuna Hosp, Sweden.
    Khan, Shahzad
    Lund Univ, Sweden.
    Sonesson, Bjorn
    Lund Univ, Sweden.
    Stackelberg, Otto
    Karolinska Inst, Sweden.
    Gillgren, Peter
    Karolinska Inst, Sweden; Soder Sjukhuset, Sweden.
    Isaksson, Jon
    Umea Univ, Sweden.
    Kragsterman, Bjorn
    Uppsala Univ, Sweden; Vasteras Hosp, Sweden.
    Gidlund, Khatereh Djavani
    Orebro Univ, Sweden.
    Horer, Tal
    Orebro Univ, Sweden.
    Sadeghi, Mitra
    Orebro Univ, Sweden.
    Wanhainen, Anders
    Uppsala Univ, Sweden; Umea Univ, Sweden.
    Semi-Conservative Treatment Versus Radical Surgery in Abdominal Aortic Graft and Endograft Infections2023In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, no 3, p. 397-406Article in journal (Refereed)
    Abstract [en]

    Objective: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort.Methods: Patients with abdominal AGI related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for the definition of AGI. Multivariable regression was performed to identify factors associated with mortality.Results: One hundred and sixty-nine patients with surgically treated abdominal AGI were identified, comprising 43 SC (14 endografts; 53% with a graft enteric fistula [GEF] in total) and 126 RS (26 endografts; 50% with a GEF in total). The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan -Meier estimated five year survival for SC vs. RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan -Meier estimated five year survival for SC patients with a GEF vs. without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC with RS (45.4% vs. 19.3%; p &lt; .001). In a Cox regression model adjusting for confounders, there was no difference in five year survival comparing SC vs. RS (HR 1.0, 95% CI 0.6 -1.5).Conclusion: In this national AGI cohort, there was no mortality difference comparing SC and RS for AGI when adjusting for comorbidities. Presence of GEF probably negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC treated patients.

  • 29.
    Guan, Ruicong
    et al.
    Sun Yat Sen Univ, Peoples R China; Sun Yat Sen Univ, Peoples R China.
    Zeng, Kuan
    Sun Yat Sen Univ, Peoples R China.
    Gao, Minnan
    Sun Yat Sen Univ, Peoples R China.
    LI, Jianfen
    Sun Yat Sen Univ, Peoples R China.
    Jiang, Huiqi
    Sun Yat Sen Univ, Peoples R China.
    LI, Jingwen
    Sun Yat Sen Univ, Peoples R China.
    Zhang, L. U.
    Sun Yat Sen Univ, Peoples R China.
    LI, Jingwen
    Sun Yat Sen Univ, Peoples R China.
    Zhang, B. I. N.
    Sun Yat Sen Univ, Peoples R China.
    Liu, Yuqiang
    Sun Yat Sen Univ, Peoples R China.
    Liu, Zhuxuan
    Sun Yat Sen Univ, Peoples R China.
    Wang, Dian
    Sun Yat Sen Univ, Peoples R China.
    Yang, Yanqi
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Sun Yat Sen Univ, Peoples R China.
    Dexmedetomidine alleviates oxygen and glucose deprivation-induced apoptosis in mesenchymal stem cell via downregulation of MKP-12022In: Biocell (Mendoza), ISSN 0327-9545, E-ISSN 1667-5746, Vol. 46, no 11, p. 2455-2463Article in journal (Refereed)
    Abstract [en]

    Bone marrow mesenchymal stem cell (MSC)-based therapy is a novel candidate for heart repair. But ischemia-reperfusion injury leads to low viability of MSC. Dexmedetomidine (Dex) has been found to protect neurons against ischemia-reperfusion injury. It remains unknown if Dex could increase the viability of MSCs under ischemia. The present study is to observe the potential protective effect of Dex on MSCs under ischemia and its underlying mechanisms. Specific mRNAs related to myocardial ischemia in the GEO database were selected from the mRNA profiles assessed in a previous study using microarray. The most dysregulated mRNAs of the specific ones from the above study were subject to bioinformatics analysis at our laboratory. These dysregulated mRNAs possibly regulated apoptosis of cardiomyocytes and were validated in vitro for their protective effect on MSCs under ischemia. MSCs were pre-treated with Dex at 10 mu M concentration for 24 h under oxygen-glucose deprivation (OGD). Flow cytometry and TUNEL assay were carried out to detect apoptosis in Dex-pretreated MSCs under OGD. The relative expressions of mitogen-activated protein kinase phosphatase 1 (MKP-1) and related genes were detected by quantitative polymerase chain reaction and western blotting. Microarray data analysis revealed that Dex regulates MAPK phosphatase activity. Dex significantly reduced in vitro apoptosis of MSCs under OGD, which suppressed the synthesis level of Beclin1 and light chain 3 proteins. Dex down-regulated MKP-1 expression and attenuated an OGD-induced change in the mitogen activated protein kinase 3 (MAPK3) signaling pathway. Dex increases the viability of MSC and improves its tolerance to OGD in association with the MKP-1 signaling pathway, thus suggesting the potential of Dex as a novel strategy for promoting MSCs efficacy under ischemia.

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  • 30.
    Guan, Ruicong
    et al.
    Sun Yat sen Univ, Peoples R China; Sun Yat sen Univ, Peoples R China.
    Zeng, Kuan
    Sun Yat sen Univ, Peoples R China.
    Zhang, Bin
    Sun Yat sen Univ, Peoples R China.
    Gao, Minnan
    Sun Yat sen Univ, Peoples R China.
    Li, Jianfen
    Sun Yat sen Univ, Peoples R China.
    Jiang, Huiqi
    Sun Yat sen Univ, Peoples R China.
    Liu, Yuqiang
    Sun Yat sen Univ, Peoples R China.
    Qiang, Yongjia
    Sun Yat sen Univ, Peoples R China.
    Liu, Zhuxuan
    Sun Yat sen Univ, Peoples R China.
    Li, Jingwen
    Sun Yat sen Univ, Peoples R China.
    Yang, Yanqi
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Sun Yat sen Univ, Peoples R China.
    Plasma Exosome miRNAs Profile in Patients With ST-Segment Elevation Myocardial Infarction2022In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 9, article id 848812Article in journal (Refereed)
    Abstract [en]

    BackgroundCirculating microRNAs (miRNAs) have been found to have different expressions in different phases of acute myocardial infarction. The profiles of plasma exosome miRNAs in patients with ST-segment elevation myocardial infarction (STEMI) at 3-6 months postinfarction are unknown. ObjectiveThe aim of this study was to assess the profiles of plasma exosome miRNAs in patients with STEMI in comparison with healthy volunteers and to select specific exosome miRNAs related to pathophysiological changes post-STEMI. MethodsPlasma and echocardiography parameters were collected from 30 patients 3-6 months after STEMI and 30 healthy volunteers. Plasma exosome miRNAs were assessed by using high-throughput sequence (Illumina HiSeq 2500) and profile of the plasma exosome miRNAs was established in 10 patients and 6 healthy volunteers. The specific exosome miRNAs related to heart diseases were selected according to the TargetScan database. The specificity of the selected exosome miRNAs was evaluated in additional 20 post-STEMI patients and 24 healthy volunteers by using quantitative PCR (qPCR). Left ventricular remodeling (LVR) was defined using the European Association of Cardiovascular Imaging criteria according to echocardiography examination. Correlations between expression of the specific miRNAs and echocardiography parameters of LVR were assessed using the Spearman correlation analysis. ResultsTwenty eight upregulated miRNAs and 49 downregulated miRNAs were found in patients 3-6 months after STEMI (p &lt; 0.01) in comparison with the healthy volunteers. The two least expressed and heart-related exosome miRNAs were hsa-miR-181a-3p (0.64-fold, p &lt; 0.01) and hsa-miR-874-3p (0.50-fold, p &lt; 0.01), which were further confirmed by using qPCR and demonstrated significant specificity in another 20 patients with post-STEMI comparing to 24 healthy volunteers [area under the curve (AUC) = 0.68, p &lt; 0.05; AUC = 0.74, p &lt; 0.05]. The expression of hsa-miR-181a-3p was downregulated in patients with LV adverse remodeling in comparison with patients without LV adverse remodeling and healthy volunteers. ConclusionCirculating exosome miR-874-3p and miR-181a-3p were downregulated in patients with STEMI postinfarction. Exosome hsa-miR-181a-3p might play a potential role in the development of LVR in patients with post-STEMI.

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  • 31.
    Guidet, Bertrand
    et al.
    Sorbonne Univ, France.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Boumendil, Ariane
    Hop St Antoine, France.
    Leaver, Susannah
    Res Lead Crit Care Directorate St Georges Hosp, England.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Boulanger, Carol
    Royal Devon and Exeter NHS Fdn Trust, England.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Morandi, Alessandro
    Hosp Ancelle Cremona Italy, Italy.
    Andersen, Finn
    Alesund Hosp, Norway.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa Tsakal Larissa, Greece.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Walther, Sten M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Oeyen, Sandra
    Univ Ghent, Belgium.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Cecconi, Maurizio
    Humanitas Clin and Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    European Wellness Int, Ukraine.
    Elhadi, Muhammed
    Alkhums Hosp, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Flaatten, Hans
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study2020In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 46, p. 57-69Article in journal (Refereed)
    Abstract [en]

    Purpose Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of daily life in addition to the presence of comorbidity and polypharmacy and to assess their influence on 30-day survival. Methods Prospective cohort study with 242 ICUs from 22 countries. Patients 80 years or above acutely admitted over a six months period to an ICU between May 2018 and May 2019 were included. In addition to common patients characteristics and disease severity, we collected information on specific geriatric syndromes as potential predictive factors for 30-day survival, frailty (Clinical Frailty scale) with a CFS amp;gt; 4 defining frail patients, cognitive impairment (informant questionnaire on cognitive decline in the elderly (IQCODE) with IQCODE amp;gt;= 3.5 defining cognitive decline, and disability (measured the activity of daily life with the Katz index) with ADL amp;lt;= 4 defining disability. A Principal Component Analysis to identify co-linearity between geriatric syndromes was performed and from this a multivariable model was built with all geriatric information or only one: CFS, IQCODE or ADL. Akaikes information criterion across imputations was used to evaluate the goodness of fit of our models. Results We included 3920 patients with a median age of 84 years (IQR: 81-87), 53.3% males). 80% received at least one organ support. The median ICU length of stay was 3.88 days (IQR: 1.83-8). The ICU and 30-day survival were 72.5% and 61.2% respectively. The geriatric conditions were median (IQR): CFS: 4 (3-6); IQCODE: 3.19 (3-3.69); ADL: 6 (4-6); Comorbidity and Polypharmacy score (CPS): 10 (7-14). CFS, ADL and IQCODE were closely correlated. The multivariable analysis identified predictors of 1-month mortality (HR; 95% CI): Age (per 1 year increase): 1.02 (1.-1.03, p = 0.01), ICU admission diagnosis, sequential organ failure assessment score (SOFA) (per point): 1.15 (1.14-1.17, p amp;lt; 0.0001) and CFS (per point): 1.1 (1.05-1.15, p amp;lt; 0.001). CFS remained an independent factor after inclusion of life-sustaining treatment limitation in the model. Conclusion We confirm that frailty assessment using the CFS is able to predict short-term mortality in elderly patients admitted to ICU. Other geriatric syndromes do not add improvement to the prediction model. Since CFS is easy to measure, it should be routinely collected for all elderly ICU patients in particular in connection to advance care plans, and should be used in decision making.

  • 32.
    Haas, Lenneke E. M.
    et al.
    Diakonessenhuis Utrecht, Netherlands.
    Boumendil, Ariane
    Hop St Antoine, France.
    Flaatten, Hans
    Univ Bergen, Norway.
    Guidet, Bertrand
    Sorbonne Univ, France.
    Ibarz, Mercedes
    Univ Hosp Sagrat Cor Barcelona, Spain.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Moreno, Rui
    Univ Lisboa Cent, Portugal.
    Morandi, Alessandro
    Hosp Ancelle, Italy; Parc Sanitari Pere Virgili, Spain; Vail dHebron Inst Res, Spain.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    Walther, Sten
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Leaver, Susannah
    NHS Fdn Trust, England.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Boulanger, Carole
    Royal Devon & Exeter NHS Fdn Trust, England.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Cecconi, Maurizio
    IRCCS, Italy; Humanitas Univ, Italy.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    ICU, Ukraine.
    Elhadi, Muhammed
    Univ Tripoli, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs2021In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 50, no 5, p. 1719-1727Article in journal (Refereed)
    Abstract [en]

    Background: Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients &gt;= 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective: To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. Design: Prospective cohort study. Setting: 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. Subjects: Acutely admitted ICU patients aged &gt;= 80 years with sequential organ failure assessment (SOFA) score &gt;= 2. Methods: Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. Results: Out of 3,596 acutely admitted VIPs with SOFA score &gt;= 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P &lt; 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P &lt; 0.0001) and frailty (CFS&gt; 4): HR, 1.34 (95% CI, 1.18-1.51, P &lt; 0.0001). Conclusions: There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

  • 33.
    Hagglof, Elsa
    et al.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Bell, Max
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Zettersten, Erik
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Engerström, Lars
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Swedish Intens Care Registry, Linkoping, Sweden.
    Larsson, Emma
    Swedish Intens Care Registry, Linkoping, Sweden; Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Long-term survival after intensive care for COVID-19: a nationwide cohort study of more than 8000 patients2023In: Annals of Intensive Care, ISSN 2110-5820, E-ISSN 2110-5820, Vol. 13, no 1, article id 76Article in journal (Refereed)
    Abstract [en]

    Background Was it worth it-what is the outcome after the extended ICU (intensive care unit) length of stay for COVID-19 patients? Surprisingly, data on long-term mortality in large cohorts are lacking. We investigate long-term mortality including differences between men and women, as previous studies show that men generally suffer a more severe course of COVID-19 in terms of severity of illness and short-term mortality.Methods Nationwide cohort including all adult COVID-19 patients admitted to Swedish ICUs until August 12, 2022. Primary outcome was 360-day mortality after ICU admission. Logistic regression was used to estimate associations between demographics, comorbidities, clinical characteristics and mortality.Results In total, 8392 patients were included. Median (IQR) age was 63 (52-72) years and the majority (70.1%) were men. Among the 7390 patients with complete 360-day mortality data, 1775 (24.4%) patients died within 30 days, 2125 (28.8%) within 90 days and 2206 (29.8%) within 360 days from ICU admission. 360-day mortality was 27.1% in women and 31.0% in men. Multivariable logistic regression analysis showed increased risk of 360-day mortality in men compared to women (OR: 1.33, 95% CI: 1.17-1.52). Other variables associated with poor 360-day mortality were age, cardiac disease, COPD/asthma, diabetes, immune deficiency, chronic kidney disease, neuromuscular disease, and malignancy.Conclusion This study confirms the increased severity of disease in critically ill men with COVID-19, even in a long-term perspective. However, mortality beyond 90 days was strikingly low, indicating high probability of survival after the acute phase of illness.

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  • 34.
    Hammarskjöld, Fredrik
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Bavelaar, Herjan
    Reg Jonkoping Cty, Sweden.
    Jonsson Henningsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Microbiology. Reg Jonkoping Cty, Sweden.
    Taxbro, Knut
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single-centre study2024In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    Background Patients with severe coronavirus disease 2019 (COVID) pneumonia and acute respiratory distress syndrome (C-ARDS) on invasive mechanical ventilation (IMV) have been found to be prone to having other microbial findings than severe acute respiratory syndrome coronavirus 2 (SARS-2)-CoV-19 in the bronchoalveolar lavage (BAL) fluid at intubation causing a superinfection. These BAL results could guide empirical antibiotic treatment in complex clinical situations. However, there are limited data on the relationship between microbial findings in the initial BAL at intubation and later ventilator-associated pneumonia (VAP) diagnoses. Objective To analyse the incidence of, and microorganisms responsible for, superinfections in C-ARDS patients at the time of first intubation through microbial findings in BAL fluid. To correlate these findings to markers of inflammation in plasma and later VAP development. Design Retrospective single-centre study. Setting One COVID-19 intensive care unit (ICU) at a County Hospital in Sweden during the first year of the pandemic. Patients All patients with C-ARDS who were intubated in the ICU. Results We analysed BAL fluid specimens from 112 patients at intubation, of whom 31 (28%) had superinfections. Blood levels of the C-reactive protein, procalcitonin, neutrophil granulocytes, and lymphocytes were indistinguishable between patients with and without a pulmonary superinfection. Ninety-eight (88%) of the patients were treated with IMV for more than 48 h and of these patients, 37% were diagnosed with VAP. The microorganisms identified in BAL at the time of intubation are normally found at the oral, pharyngeal, and airway sites. Only one patient had an indistinguishable bacterial strain responsible for both superinfection at intubation and in VAP. Conclusions One fourth of the patients with C-ARDS had a pulmonary superinfection in the lungs that was caused by another microorganism identified at intubation. Routine serum inflammatory markers could not be used to identify this complication. Microorganisms located in BAL at intubation were rarely associated with later VAP development.

  • 35.
    Hellstrom, Patrik
    et al.
    Linnaeus Univ, Sweden.
    Israelsson, Johan
    Linnaeus Univ, Sweden; Reg Kalmar Cty, Sweden.
    Hellstrom, Amanda
    Linnaeus Univ, Sweden.
    Hjelm, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Broström, Anders
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden; Western Norway Univ Appl Sci, Norway.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Reg Kalmar Cty, Sweden.
    Is insomnia associated with self-reported health and life satisfaction in cardiac arrest survivors? A cross-sectional survey2023In: Resuscitation Plus, E-ISSN 2666-5204, Vol. 15, article id 100455Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia symptoms seem to be common in cardiac arrest survivors but their associations with important outcomes such as self reported health and life satisfaction have not previously been reported during the early post-event period. Therefore, the aim of the study was to investigate whether symptoms of insomnia are associated with self-reported health and life satisfaction in cardiac arrest survivors six months after the event.Methods: This multicentre cross-sectional survey included cardiac arrest survivors =18 years. Participants were recruited six months after the event from five hospitals in southern Sweden, and completed a questionnaire including the Minimal Insomnia Symptom Scale, EQ-5D-5L, Health Index, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale. Data were analysed using the Mann-Whitney U test, linear regression, and ordinal logistic regression. The regression analyses were adjusted for demographic and medical factors.Results: In total, 212 survivors, 76.4% males, with a mean age of 66.6 years (SD = 11.9) were included, and of those, 20% reported clinical insomnia. Insomnia was significantly associated with all aspects of self-reported health (p &lt; 0.01) and life satisfaction (p &lt; 0.001), except mobility (p = 0.093), self-care (p = 0.676), and usual activities (p = 0.073).Conclusion: Insomnia plays a potentially important role for both health and life satisfaction in cardiac arrest survivors. Screening for sleep problems should be part of post cardiac arrest care and follow-up to identify those in need of further medical examination and treatment.

  • 36.
    Hellström, Amanda
    et al.
    Linnaeus Univ, Sweden.
    Bremer, Anders
    Linnaeus Univ, Sweden.
    Gunnarsson, Lise-Lotte
    Linnaeus Univ, Sweden.
    Hjelm, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Sleep in cardiac arrest survivors2023In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 26, no 6, p. 870-877Article in journal (Refereed)
    Abstract [en]

    Background Insomnia, sleep apnoea and sleep loss are risk factors for the development of cardiovascular diseases. Most research on sleep disturbances includes patients with heart failure, while the role of sleep in sudden cardiac arrest survivors (SCA) has been only partially investigated and understood. Sleep-related breathing disorders and obstructive sleep apnoea increase illness and mortality in the aftermath of SCA. Also, post-traumatic stress is evident in SCA survivors, where sleep disruptions are some of the main symptoms of the condition. Consequently, it is important to identify sleep problems in SCA survivors at an early stage to avoid unnecessary suffering. Purpose The aim of this study was to investigate registered nurses perceptions of SCA survivors sleep, both in hospital and after discharge. Methods This was an explorative interview study with a phenomenographic approach. Nineteen registered nurses (RNs) varying in age, sex and years in the profession participated. Findings The nurses perceptions of SCA survivors sleep were categorized as: "The observer - noticing behaviours, emotions and habits of the patient that affect sleep", "The oblivious witness - attitudes that hinder the ability to recognise sleep behaviours", and "The practitioner - advising and medicating for sleep". The outcome space showed that the nurses detected both obvious and subtle signs relating to patients sleep. However, attitudes hindering the recognition of sleep behaviours were independent of acting as an observer or practitioner. If nothing unforeseen was observed, or if the patient did not spontaneously raise the subject, sleep was considered less important than other health problems in SCA survivors. Conclusions Although the nurses knew that SCA survivors suffered from poor sleep, they failed to reflect on the consequences for the patient. Nurses feelings of insufficient knowledge about sleep, as well as their omittance of sleep in the follow-up documentation could leave sleep issues unaddressed and cause unnecessary patient suffering. Relevance to clinical practice Nurses need increased knowledge and training to enable them to detect subtle signs of sleep problems in SCA survivors.

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  • 37.
    Holm, Jonas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Cederholm, Ingemar
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Alehagen, Urban
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lindahl, Tomas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Szabó, Zoltán
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM, MR-proANP, hs-CRP and sP-selectin plasma levels in the perioperative period2020In: Biomarkers, ISSN 1354-750X, E-ISSN 1366-5804, Vol. 25, no 3, p. 296-304Article in journal (Refereed)
    Abstract [en]

    Background: For many biomarkers in cardiac surgery, there is a lack of knowledge regarding the normal dynamics of plasma levels during the perioperative course. The aim of this study was to investigate the perioperative dynamics of MR-proADM, MR-proANP, hs-CRP and sP-selectin in cardiac surgery. Method: A prospective observational pilot study with 20 patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB). Plasma samples were taken for each patient and biomarker during the pre-, per- and postoperative period until Day 6 postoperatively. Results: MR-proADM increased significantly from 0.62 [IQR; 0.54-0.93] nmol/L preoperatively to 1.20 [1.04-1.80] nmol/L postoperative Day 1. MR-proANP increased significantly from 125 [77-152] pmol/L preoperatively to 198 [168-307] pmol/L on weaning from CPB. hs-CRP increased significantly from 2.5 mg/L [0.4-12] preoperatively to peak at 208 mg/L [186-239] postoperative Day 3. The preoperative level of sP-selectin at 23.0 [21.3-26.3] ng/mL initially fell at weaning from CPB, followed by a significant peak of 25.5 [22.7-27.7] ng/mL 8 h postoperatively. Conclusions: The findings in this study may help to understand the physiology of the biomarkers analysed and their response to cardiac surgical trauma including CPB. Furthermore, these findings will guide us in further research on the clinical usefulness of these biomarkers.

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  • 38.
    Holm, Jonas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Ferrari, Gabriele
    Orebro Univ, Sweden.
    Holmgren, Anders
    Umea Univ, Sweden; Umea Univ, Sweden.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Friberg, Örjan
    Orebro Univ, Sweden.
    Vidlund, Mårten
    Orebro Univ, Sweden; Sahlgrens Univ Hosp, Sweden.
    Svedjeholm, Rolf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial2022In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 19, no 5, article id e1003997Article in journal (Refereed)
    Abstract [en]

    Background Animal and human data suggest that glutamate can enhance recovery of myocardial metabolism and function after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction after coronary artery bypass surgery (CABG). We investigated whether glutamate infusion can reduce rises of NT-proBNP in moderate- to high-risk patients after CABG. Methods and findings A prospective, randomized, double-blind study enrolled patients from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4 academic cardiac surgery centers in Sweden. Patients underwent CABG +/- valve procedure and had left ventricular ejection fraction &lt; 0.30 or EuroSCORE II &lt; 3.0. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the aortic cross-clamp, then continued for another 150 minutes. Patients, staff, and investigators were blinded to the treatment. The primary endpoint was the difference between preoperative and day-3 postoperative NT-proBNP levels. Analysis was intention to treat. We studied 303 patients (age 74 & PLUSMN; 7 years; females 26%, diabetes 47%), 148 receiving glutamate group and 155 controls. There was no significant difference in the primary endpoint associated with glutamate administration (5,390 & PLUSMN; 5,396 ng/L versus 6,452 & PLUSMN; 5,215 ng/L; p = 0.086). One patient died & LE;30 days in the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12). No adverse events linked to glutamate were observed. A significant interaction between glutamate and diabetes was found (p = 0.03). Among patients without diabetes the primary endpoint (mean 4,503 +/- 4,846 ng/L versus 6,824 & PLUSMN; 5,671 ng/L; p = 0.007), and the incidence of acute kidney injury (11% versus 29%; p = 0.005) was reduced in the glutamate group. These associations remained significant after adjusting for differences in baseline data. The main limitations of the study are: (i) it relies on a surrogate marker for heart failure; and (ii) the proportion of patients with diabetes had almost doubled compared to the cohort used for the sample size estimation. Conclusions Infusion of glutamate did not significantly reduce postoperative rises of NT-proBNP. Diverging results in patients with and without diabetes agree with previous observations and suggest that the concept of enhancing postischemic myocardial recovery with glutamate merits further evaluation.

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  • 39.
    Holm, Jonas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Association of Glutamate Infusion With Risk of Acute Kidney Injury After Coronary Artery Bypass Surgery A Pooled Analysis of 2 Randomized Clinical Trials2024In: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, no 1, article id e2351743Article in journal (Refereed)
    Abstract [en]

    Importance Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality, and measures to prevent AKI have had limited success. Glutamate has been reported to enhance natural postischemic recovery of the heart, but not among animals and humans with diabetes. Objective To summarize pooled results from the GLUTAMICS (Glutamate for Metabolic Intervention in Coronary Surgery) trials regarding the effect of glutamate on postoperative AKI among patients without diabetes undergoing coronary artery bypass graft (CABG) surgery. Design, Setting, and Participants Data on a total of 791 patients without diabetes from 2 prospective, randomized, double-blind multicenter trials performed at 5 cardiac surgery centers in Sweden between October 4, 2005, and November 12, 2009, and between November 15, 2015, and September 30, 2020, were pooled. Patients had acute coronary syndrome, left ventricular ejection fraction of 0.30 or less, or a European System for Cardiac Risk Evaluation II score of 3.0 or more and underwent CABG with or without additional valve procedure. Statistical analysis was performed from May to November 2023. Interventions Intravenous infusion of 0.125-M l-glutamic acid or saline at 1.65 mL/kg/h for 2 hours during reperfusion, after which the infusion rate was halved and an additional 50 mL was given. Main Outcomes and Measures The primary end point was AKI, defined as postoperative increase of plasma creatinine of 50% or more, corresponding to the Risk stage or higher in the Risk, Injury, Failure, Loss, and End-Stage kidney disease (RIFLE) criteria. Results A total of 791 patients without diabetes (391 who received glutamate [mean (SD) age, 69.3 (9.1) years; 62 women (15.9%)] and 400 controls [mean (SD) age, 69.6 (9.5) years; 73 women (18.3%)]) were randomized. Baseline data did not differ between groups. Glutamate was associated with a significantly lower risk of AKI (relative risk, 0.49 [95% CI, 0.29-0.83]). Dialysis was required for 2 patients in the glutamate group and 5 patients in the control group. In multivariable analysis, glutamate remained significantly associated with a protective effect against AKI (odds ratio, 0.47 [95% CI, 0.26-0.86]). In the glutamate and control groups, the rate of postoperative mortality at 30 days or less was 0.5% (2 of 391) vs 1.0% (4 of 400), and the rate of stroke at 24 hours or less was 0.8% (3 of 391) vs 1.8% (7 of 400). Conclusions and Relevance In this pooled analysis of 2 randomized clinical trials, infusion of glutamate was associated with a markedly lower risk of AKI after CABG among patients without diabetes. The findings are exploratory and need to be confirmed in prospective trials.

  • 40.
    Holm, Jonas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Glutamate Infusion Reduces Myocardial Dysfunction after Coronary Artery Bypass Grafting According to NT-proBNP: Summary of 2 Randomized Controlled Trials (GLUTAmate for Metabolic Intervention in Coronary Surgery [GLUTAMICS I-II])2023In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 118, no 5, p. 930-937Article in journal (Refereed)
    Abstract [en]

    Background: Glutamate is reported to enhance the recovery of oxidative metabolism and contractile function of the heart after ischemia. The effect appears to be blunted in diabetic hearts. Elevated plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction. In the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS) II trial, the proportion of patients with diabetes had nearly doubled to 47% compared with the cohort used for sample size estimation, and a significant effect on the postoperative rise in NT-proBNP was only observed in patients without diabetes. Objective: We aimed to summarize the pooled NT-proBNP results from both GLUTAMICS trials and address the impact of diabetes. Methods: Data from 2 prospective, randomized, double-blind multicenter trials with similar inclusion criteria and endpoints were pooled. Patients underwent a coronary artery bypass grafting (CABG) +/- valve procedure and had a left-ventricular ejection fraction of &lt;= 0.30 or a European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) of &gt;= 3.0 with at least 1 cardiac risk factor. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was started 10-20 min before reperfusion and continued for 150 min. The primary endpoint was the difference between pre-operative and day 3 postoperative NT-proBNP levels. Results: A total of 451 patients, 224 receiving glutamate and 227 controls, fulfilled the inclusion criteria. Glutamate was associated with a reduced primary endpoint (5344 +/- 5104 ng/L and 6662 +/- 5606 ng/L in glutamate and control groups, respectively; P = 0.01). Postoperative mortality at &lt;= 30 d was 0.9% and 3.5% (P = 0.11), whereas stroke at &lt;= 24 h was 0.4% and 2.6% in glutamate and control groups, respectively (P = 0.12). No adverse events related to glutamate were observed. A significant interaction regarding the primary endpoint was only detected between glutamate and insulin -treated diabetes groups (P = 0.04). Among patients without insulin-treated diabetes, the primary endpoint was 5047 +/- 4705 ng/L and 7001 +/- 5830 ng/L in the glutamate and control groups, respectively (P = 0.001). Conclusions: Infusion of glutamate reduced the postoperative rise in NT-proBNP after CABG in medium-to high-risk patients. A significantly blunted effect was observed only in insulin-treated patients with diabetes. Clinical trial details: This trial was registered at www.clinicaltrials.gov as NCT02592824.

  • 41.
    Holmberg, Erica
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Tamas, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Granfeldt, Hans
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Right ventricular function in severe aortic stenosis assessed by echocardiography and MRI2023In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097XArticle in journal (Refereed)
    Abstract [en]

    Background: The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation.Methods: Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) &lt; 17 mm, RV free wall strain (RVFWS) &gt; -20% by TTE and RV ejection fraction (RVEF) &lt;50% by CMR.Results: Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF.Conclusion: In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.

  • 42.
    Holmbom, Martin
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Andersson, Maria
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Eklund, Dan
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Sobczynski, Pernilla
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Wilhelms, Daniel
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences, Forum Östergötland.
    Balkhed Östholm, Åse
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Hanberger, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 11, article id e052582Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.

    Methods A retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.

    Results Of the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p&amp;lt;0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p&amp;lt;0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p&amp;lt;0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p&amp;lt;0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p&amp;lt;0.01. In a multivariable model, prehospital delay &amp;gt;24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p&amp;lt;0.01.

    Conclusion Prehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.All data relevant to the study are included in the article or uploaded as supplemental information.

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  • 43.
    Horer, Tal M.
    et al.
    Orebro Univ Hosp, Sweden; Univ Orebro, Sweden.
    Pirouzram, Artai
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Khan, Mansoor
    Brighton & Sussex Univ Hosp, England.
    Brenne, Megan
    Univ Calif Riverside, CA 92521 USA.
    Cotton, Bryan
    Univ Texas Hlth Sci Ctr Houston, TX 77030 USA.
    Duchesne, Juan
    Dept Surg Tulane, LA USA.
    Ferrada, Paula
    VCU Surg Trauma Crit Care & Emergency Surg, VA USA.
    Kauvar, David
    San Antonio Mil Med Ctr, TX USA.
    Kirkpatrick, Andrew
    Reg Trauma Serv Foothills Med Ctr, Canada; Univ Calgary, Canada; Univ Calgary, Canada; Canadian Forces Hlth Serv, Canada.
    Ordonez, Carlos
    Univ Valle, Colombia.
    Perreira, Bruno
    Univ Estadual Campinas, Brazil.
    Roberts, Derek
    Univ Ottawa, Canada.
    Endovascular Resuscitation and Trauma Management (EVTM)-Practical Aspects and Implementation2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 37-41Article in journal (Refereed)
    Abstract [en]

    In recent years there has been a tremendous increase in hemorrhage control by endovascular methods. Traumatic and non-traumatic hemorrhage is being more frequently managed with endografts, embolization agents, and minimal invasive methods. These methods initially were used in hemodynamically stable patients only, whereas now these are being implemented in acute settings and hemodynamically unstable patients. The strategy of using endovascular and combined open-endo methods approach for hemodynamic instability in trauma and non-trauma patients has been named EVTM- EndoVascular resuscitation and Trauma Management. The EVTM concept will be presented in this article, describing how it is developed and used, as well as its limitations and future aspects.

  • 44.
    Hultkvist, Henrik
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Nylander, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Tamas, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Holm, Jonas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Maret, Eva
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Evaluation of left ventricular diastolic function in patients operated for aortic stenosis2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263824Article in journal (Refereed)
    Abstract [en]

    Background Left ventricular diastolic dysfunction is common in patients with aortic valve stenosis (AS) and reportedly affects prognosis after surgical aortic valve replacement (SAVR). Here we investigated whether and how diastolic function (assessed following the most recent guidelines) was affected by SAVR, and whether preoperative diastolic function affected postoperative outcome. We also examined whether long-term mortality was associated with preoperative NT-proBNP and postoperative heart failure (PHF). Methods We performed a prospective observational study of 273 patients with AS who underwent AVR with or without concomitant coronary artery bypass surgery. Of these patients, 247 were eligible for assessment of left ventricular (LV) filling pressure. Preoperatively and at the 6-month postoperative follow-up, we measured N-terminal pro-B type natriuretic peptide (NT-proBNP) in serum and assessed diastolic function with Doppler echocardiography. PHF was diagnosed using prespecified criteria. Multivariable logistic regression was performed to explore variables associated with high LV filling pressure. Cox regression was performed to explore variables associated with mortality, accounting for timeto-event. Results At the time of surgery, 22% (n = 54) of patients had diastolic dysfunction expressed as high LV filling pressure. Of these 54 patients, 27 (50%) showed postoperative diastolic function improvement. Among the 193 patients with preoperative low LV filling pressure, 24 (12%) showed postoperative diastolic function deterioration. Increased long-term mortality was associated with PHF and high preoperative NT-proBNP, but not with preoperative or postoperative diastolic dysfunction. Cox regression revealed the following independent risk factors for long-term mortality: diabetes, renal dysfunction, preoperative NT-proBNP&gt;960 ng/L, age, and male gender. Conclusions Surgery for aortic stenosis improved diastolic function in patients with high LV filling pressure in 50% of the patients. Our results could not confirm the previously suggested role of diastolic dysfunction as a marker for poor long-term survival after SAVR. Our findings showed that both PHF and high preoperative NT-proBNP were associated with long-term mortality.

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  • 45.
    Jiang, Huiqi
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Sun Yat Sen Univ Med Sci, Peoples R China.
    Holm, Jonas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Friberg, Örjan
    Orebro Univ, Sweden.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Mårten
    Orebro Univ, Sweden.
    Bashir, Tajik
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Health, Medicine and Caring Sciences.
    Yang, Yanqi
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Sun Yat Sen Univ Med Sci, Peoples R China.
    Svedjeholm, Rolf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Utility of NT-proBNP as an objective marker of postoperative heart failure after coronary artery bypass surgery: a prospective observational study2021In: Perioperative Medicine, E-ISSN 2047-0525, Vol. 10, no 1, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult. We investigated the utility of postoperative NT-proBNP as an objective marker of PHF after coronary artery bypass surgery (CABG). Methods: Prospective study on 382 patients undergoing isolated CABG for acute coronary syndrome. NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A blinded Endpoints Committee used prespecified criteria for PHF. Use of circulatory support was scrutinized. Results: After adjusting for confounders PHF was associated with 1.46 times higher NT-proBNP on POD1 (p = 0.002), 1.54 times higher on POD3 (p &lt; 0.0001). In severe PHF, NT-proBNP was 2.18 times higher on POD1 (p = 0.001) and 1.81 times higher on POD3 (p = 0.019). Postoperative change of NT-proBNP was independently associated with PHF (OR 5.12, 95% CI 1.86-14.10, p = 0.002). The use of inotropes and ICU resources increased with incremental quartiles of postoperative NT-proBNP. Conclusions: Postoperative NT-proBNP can serve as an objective marker of the severity of postoperative myocardial dysfunction. Due to overlap in individuals, NT-proBNP is useful mainly for comparisons at cohort level. As such, it provides a tool for study purposes when an unbiased assessment of prevention or treatment of PHF is desirable.

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  • 46.
    Jiang, Huiqi
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Sun Yat Sen Univ, Peoples R China.
    Holm, Jonas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Marten
    Orebro Univ, Sweden.
    Vánky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Friberg, Orjan
    Orebro Univ, Sweden.
    Yang, Yanqi
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Sun Yat Sen Univ, Peoples R China.
    Svedjeholm, Rolf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    The impact of glutamate infusion on postoperative NT-proBNP in patients undergoing coronary artery bypass surgery: a randomized study2020In: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, JOURNAL OF TRANSLATIONAL MEDICINE, Vol. 18, no 1, article id 193Article in journal (Refereed)
    Abstract [en]

    Background

    Glutamate, a key intermediate in myocardial metabolism, may enhance myocardial recovery after ischemia and possibly reduce the incidence and severity of postoperative heart failure in coronary artery bypass surgery (CABG). N-terminal pro-B-type natriuretic peptide (NT-proBNP) can be used to assess postoperative heart failure (PHF) after CABG. Our hypothesis was that glutamate enhances myocardial recovery in post-ischemic heart failure and, therefore, will be accompanied by a mitigated postoperative increase of NT-proBNP.

    Methods

    Substudy of the GLUTAmate for Metabolic Intervention in Coronary Surgery (GLUTAMICS) trial (ClinicalTrials.gov Identifier: NCT00489827) a prospective triple-center double-blind randomized clinical trial on 399 patients undergoing CABG with or without concomitant procedure for acute coronary syndrome at three Swedish Cardiac Surgery centres (Linköping, Örebro, and Karlskrona) from May 30, 2007 to November 12, 2009. Patients were randomly assigned to intravenous infusion of 0.125 M L-glutamic acid or saline (1.65 mL/kg of body weight per hour) intraoperatively and postoperatively. Plasma NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A Clinical Endpoints Committee, blinded to both intervention and NT-proBNP used prespecified criteria to diagnose PHF. The primary endpoints were the absolute levels of postoperative NT-proBNP and the difference between preoperative and postoperative levels of NT-proBNP.

    Results

    Overall no significant difference was detected in postoperative NT-proBNP levels between groups. However, in high-risk patients (upper quartile of EuroSCORE II ≥ 4.15; glutamate group n = 56; control group n = 45) glutamate was associated with significantly lower postoperative increase of NT-proBNP (POD3-Pre: 3900 [2995–6260] vs. 6745 [3455–12,687] ng•L−1, p = 0.012) and lower NT-proBNP POD3 (POD3: 4845 [3426–7423] vs. 8430 [5370–14,100] ng•L−1, p = 0.001). After adjusting for significant differences in preoperative demographics, NT-proBNP POD3 in the glutamate group was 0.62 times of that in the control group (p = 0.002). Patients in the glutamate group also had shorter ICU stay (21 [19–26] vs. 25 [22–46] h, p = 0.025) and less signs of myocardial injury (Troponin T POD3 (300 [170–500] vs. 560 [210–910] ng•L−1, p = 0.025).

    Conclusions

    Post hoc analysis of postoperative NT-proBNP suggests that intravenous infusion of glutamate may prevent or mitigate myocardial dysfunction in high-risk patients undergoing CABG. Further studies are necessary to confirm these findings.

    Trial registration Swedish Medical Products Agency 151:2003/70403 (prospectively registered with amendment about this substudy filed March 17, 2007). ClinicalTrials.gov Identifier: NCT00489827 (retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=1&rank=1

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  • 47.
    Johnsson, Jesper
    et al.
    Lund Univ, Sweden.
    Dankiewicz, Josef
    Lund Univ, Sweden.
    Walther, Sten
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Nielsen, Niklas
    Lund Univ, Sweden.
    Hazards of adjustment in studies on temperature interventions2021In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 160, p. 140-141Article in journal (Other academic)
    Abstract [en]

    n/a

  • 48.
    Juhlin, D.
    et al.
    Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
    Hammarskjöld, Fredrik
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
    Mernelius, S.
    Microbiology Laboratory, Department of Laboratory Services, Division of Medical Services, Ryhov County Hospital, Jönköping, Sweden.
    Taxbro, K.
    Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Microbiological colonization of peripheral venous catheters: a prospective observational study in a Swedish county hospital2021In: Infection Prevention in Practice, E-ISSN 2590-0889, Vol. 3, no 3, article id 100152Article in journal (Refereed)
    Abstract [en]

    Background: Most peripheral venous catheters (PVCs) used in Scandinavia are fitted with an injection port, creating an open PVC system. This port is difficult to disinfect, which may lead to the introduction of micro-organisms upon use.

    Aim: To investigate the prevalence of microbiological colonization of the injection port and internal lumen of ported PVCs with a minimum dwell time of 48 h at sample collection.

    Methods: Adult patients admitted to different medical and surgical departments and the intensive care unit were invited to participate in this prospective observational study. With the PVC in situ, the injection port and internal lumen were swabbed and cultured separately. Demographic and clinical data were collected to compare patients with colonized and non-colonized PVCs.

    Findings: In total, 300 PVCs from 300 patients were analysed. Of these, 33 patients (11.0%) had at least one positive culture. The colonization locations were as follows: port only, 26 (8.7%); internal lumen only, 5 (1.7%); and port and internal lumen, 2 (0.7%). The colonization rate was significantly higher in the injection port than in the internal lumen (P<0.0001). A ported PVC inserted in the hand incurred a significant risk of colonization (P=0.03). The odds ratio for colonization among patients in the infectious diseases department was 0.1 (95% confidence interval 0.1-1; P<0.06) compared with patients in the medical department.

    Conclusion: This study showed that 11% of ported PVCs were colonized by micro-organisms, with the vast majority (8.7%) of colonization occurring in the injection port.

    Clinical trial registration: ClinicalTrials.gov; ID NCT03351725.

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  • 49.
    Karason, Kristjan
    et al.
    Sahlgrens Univ Hosp, Sweden.
    Lund, Lars H.
    Karolinska Univ Hosp, Sweden.
    Dalen, Magnus
    Karolinska Univ Hosp, Sweden.
    Bjorklund, Erik
    Uppsala Univ Hosp, Sweden.
    Grinnemo, Karl
    Uppsala Univ Hosp, Sweden.
    Braun, Oscar
    Skane Univ Hosp, Sweden.
    Nilsson, Johan
    Skane Univ Hosp, Sweden.
    van der Wal, Henriette
    Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Holm, Jonas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Hübbert, Laila
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Norrköping.
    Lindmark, Krister
    Umea Univ Hosp, Sweden.
    Szabo, Barna
    Orebro Univ Hosp, Sweden.
    Holmberg, Erik
    Sahlgrens Univ Hosp, Sweden.
    Dellgren, Goran
    Sahlgrens Univ Hosp, Sweden.
    Randomized trial of a left ventricular assist device as destination therapy versus guideline-directed medical therapy in patients with advanced heart failure. Rationale and design of the SWEdish evaluation of left Ventricular Assist Device (SweVAD) trial2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 4, p. 739-750Article in journal (Refereed)
    Abstract [en]

    Aims Patients with advanced heart failure (AdHF) who are ineligible for heart transplantation (HTx) can become candidates for treatment with a left ventricular assist device (LVAD) in some countries, but not others. This reflects the lack of a systematic analysis of the usefulness of LVAD systems in this context, and of their benefits, limitations and cost-effectiveness. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized, non-blinded, multicentre trial that will examine the impact of assignment to mechanical circulatory support with guideline-directed LVAD destination therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs. guideline-directed medical therapy (GDMT) on survival in a population of AdHF patients ineligible for HTx. Methods A total of 80 patients will be recruited to SweVAD at the seven university hospitals in Sweden. The study population will comprise patients with AdHF (New York Heart Association class IIIB-IV, INTERMACS profile 2-6) who display signs of poor prognosis despite GDMT and who are not considered eligible for HTx. Participants will be followed for 2 years or until death occurs. Other endpoints will be determined by blinded adjudication. Patients who remain on study-assigned interventions beyond 2 years will be asked to continue follow-up for outcomes and adverse events for up to 5 years. Conclusion The SweVAD study will compare survival, medium-term benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will provide a valuable reference point to guide destination therapy strategies for patients with AdHF ineligible for HTx.

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  • 50.
    Karelis, Angelos
    et al.
    Skane Univ Hosp, Sweden; Skane Univ Hosp, Sweden.
    Sonesson, Bjorn
    Skane Univ Hosp, Sweden.
    Gallitto, Enrico
    Univ Bologna, Italy.
    Tsilimparis, Nikolaos
    Univ Heart & Vasc Ctr Hamburg, Germany.
    Forsell, Claes
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Leone, Nicola
    Univ Modena & Reggio Emilia, Italy.
    Silingardi, Roberto
    Univ Modena & Reggio Emilia, Italy.
    Mesnard, Thomas
    CHU Lille, France; Univ Lille, France.
    Sobocinski, Jonathan
    CHU Lille, France.
    Isernia, Giacomo
    Santa Maria Misericordia Hosp, Italy.
    Resch, Timothy
    Univ Copenhagen, Denmark.
    Gargiulo, Mauro
    Univ Bologna, Italy.
    Dias, Nuno V.
    Skane Univ Hosp, Sweden.
    Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study2023In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the outcomes of preserving the internal iliac artery (IIA) with iliac branched devices (IBDs) during acute endovascular repair of ruptured aortoiliac aneurysms. Material and Methods: This is a multicenter retrospective review of all consecutive patients undergoing acute endovascular repair of ruptured aortoiliac aneurysm with an IBD at 8 aortic centers between December 2012 and June 2020. A control group was used where the IIA was intentionally occluded from the same study period. The main outcome measures were 30-day mortality, major adverse events, technical success, and clinical success. Secondary outcomes were buttock claudication, primary patency, primary-assisted and secondary patency of the IBD, occurrence of endoleak types I/III, and reintervention. Values are presented as numbers and percentages or interquartile range in parenthesis. Results: Forty-eight patients were included in the study: 24 with IBD and 24 with IIA occlusion. There was no difference in demographics, cardiovascular risk factors, and aneurysm extent. Twenty (83%) of them were hemodynamically stable during the procedure as opposed to 14 (58%, p=.23) with the IIA occlusion. Technical success was achieved in all cases with a procedure time of 180 (133-254) minutes, 45 (23-65) of which were from IBD. There were 2 (8%) deaths during the first 30 days and 2 (8%) major complications unrelated to the IBD, whereas in the IIA occlusion, the figures were 10 (42%) and 7 (29%), respectively. No patient in the IBD group developed buttock claudication compared to 8 (57%, p&lt;.0001) in the IIA occlusion group; 1 (4%) patient developed bowel ischemia on both groups, with 1 in the IIA occlusion group needing resection. The median follow-up duration was 17 months (interquartile range 2-39) for the IBD group, with a primary patency of 60 +/- 14% at 3 years that went up to 92 +/- 8% with reinterventions (8 reinterventions in 6 patients). When the first 90 days were disregarded, there were no differences in survival between the groups. Conclusion: IBD is a valid alternative for maintaining the pelvic circulation for endovascular aortic aneurysm repair of ruptured aortoiliac aneurysms. The technical success and midterm outcomes are very satisfactory but require patient selection particularly regarding hemodynamic stability. The reintervention rate is considerable, mandating continuous follow-up. Clinical Impact This multicenter study demonstrates that ruptured aortoiliac aneurysms do not necessarily require mandatory occlusion of hypogastric arteries. Iliac branch devices are shown to be a valid alternative in highly selected cases, with good midterm results, even if reinterventions are required in a significant proportion of patients.

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