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  • 1.
    Abbott, T. E. F.
    et al.
    Queen Mary Univ London, England.
    Ahmad, T.
    Queen Mary Univ London, England.
    Phull, M. K.
    Barts Hlth NHS Trust, England.
    Fowler, A. J.
    Guys and St Thomass NHS Fdn Trust, England.
    Hewson, R.
    Barts Hlth NHS Trust, England.
    Biccard, B. M.
    Univ Cape Town, South Africa.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Gillies, M.
    Univ Edinburgh, Scotland.
    Pearse, R. M.
    Queen Mary Univ London, England.
    The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis2018In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, no 1, p. 146-155Article, review/survey (Refereed)
    Abstract [en]

    Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained amp;gt;= 1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); Pamp;lt;0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P = 0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); Pamp;lt;0.01; I-2 = 87%] and reduced complication rates [OR 0.73 (0.61-0.88); Pamp;lt;0.01; I-2 = 89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

  • 2.
    Cecconi, M
    et al.
    1Anaesthesia and Intensive Care, St George’s Hospital and St George’s University of London, London, UK,.
    Hochrieser, H
    Center for Medical Statistics, Informatics, and Intelligent Systems .
    Chew, Michelle
    Department of Anaesthesia and Intensive Care and Institute of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Grocott, M
    Anaesthesia and Critical Care Medicine, University of Southampton, Southampton, UK, .
    Hoeft, A
    Department of Anaesthesiology, University of Bonn,Bonn, Germany, .
    Hoste, A
    Intensive Care Unit, Ghent University Hospital, Ghent, Belgium.
    Jammer, I
    Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen 5021, Norway .
    Posch, M
    Center for Medical Statistics, Informatics, and Intelligent Systems, .
    Metnitz, P
    Clinical Department of General Anaesthesiology, Emergency- and Intensive Care Medicine, Department of Anaesthesiology and Intensive Care Medicine, LKH - University Hospital of Graz, Medical University of Graz, Austria.
    Pelosi, P
    9Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy .
    Moreno, R
    Hospital de São José, Centro Hospitalar de Lisboa Central, EPE, UCINC, Lisbon, Portugal .
    Pearse, R M
    Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK, .
    Vincent, J L
    Department of Intensive Care, Erasme Hospital Université Libre de Bruxelles, Brussels, Belgium .
    Rhodes, A
    Anaesthesia and Intensive Care, St George’s Hospital and St George’s University of London, London, UK.
    Preoperative abnormalities in serum sodium concentrations are associated with higher in-hospital mortality in patients undergoing major surgery.2016In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 116, no 1, p. 63-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Abnormal serum sodium concentrations are common in patients presenting for surgery. It remains unclear whether these abnormalities are independent risk factors for postoperative mortality.

    METHODS: This is a secondary analysis of the European Surgical Outcome Study (EuSOS) that provided data describing 46 539 patients undergoing inpatient non-cardiac surgery. Patients were included in this study if they had a recorded value of preoperative serum sodium within the 28 days immediately before surgery. Data describing preoperative risk factors and serum sodium concentrations were analysed to investigate the relationship with in-hospital mortality using univariate and multivariate logistic regression techniques.

    RESULTS: Of 35 816 (77.0%) patients from the EuSOS database, 21 943 (61.3%) had normal values of serum sodium (138-142 mmol litre(-1)) before surgery, 8538 (23.8%) had hyponatraemia (serum sodium ≤137 mmol litre(-1)) and 5335 (14.9%) had hypernatraemia (serum sodium ≥143 mmol litre(-1)). After adjustment for potential confounding factors, moderate to severe hypernatraemia (serum sodium concentration ≥150 mmol litre(-1)) was independently associated with mortality [odds ratio 3.4 (95% confidence interval 2.0-6.0), P<0.0001]. Hyponatraemia was not associated with mortality.

    CONCLUSIONS: Preoperative abnormalities in serum sodium concentrations are common, and hypernatraemia is associated with increased mortality after surgery. Abnormalities of serum sodium concentration may be an important biomarker of perioperative risk resulting from co-morbid disease.

  • 3.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    A comprehensive ovine model of blood transfusion2014In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 106, p. 153-160Article in journal (Refereed)
    Abstract [en]

    Background

    The growing awareness of transfusion-associated morbidity and mortality necessitates investigations into the underlying mechanisms. Small animals have been the dominant transfusion model but have associated limitations. This study aimed to develop a comprehensive large animal (ovine) model of transfusion encompassing: blood collection, processing and storage, compatibility testing right through to post-transfusion outcomes.

    Materials and methods

    Two units of blood were collected from each of 12 adult male Merino sheep and processed into 24 ovine-packed red blood cell (PRBC) units. Baseline haematological parameters of ovine blood and PRBC cells were analysed. Biochemical changes in ovine PRBCs were characterized during the 42-day storage period. Immunological compatibility of the blood was confirmed with sera from potential recipient sheep, using a saline and albumin agglutination cross-match. Following confirmation of compatibility, each recipient sheep (n = 12) was transfused with two units of ovine PRBC.

    Results

    Procedures for collecting, processing, cross-matching and transfusing ovine blood were established. Although ovine red blood cells are smaller and higher in number, their mean cell haemoglobin concentration is similar to human red blood cells. Ovine PRBC showed improved storage properties in saline–adenine–glucose–mannitol (SAG-M) compared with previous human PRBC studies. Seventy-six compatibility tests were performed and 17·1% were incompatible. Only cross-match compatible ovine PRBC were transfused and no adverse reactions were observed.

    Conclusion

    These findings demonstrate the utility of the ovine model for future blood transfusion studies and highlight the importance of compatibility testing in animal models involving homologous transfusions.

  • 4.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care2011In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 15, no R200Article in journal (Refereed)
    Abstract [en]

    Introduction

    Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).

    Methods

    Fifty patients with shock and mechanical ventilation were included. TTE examinations were performed daily for a total of 7 days. Methods used to assess LV systolic function were visually estimated, "eyeball" ejection fraction (EBEF), the Simpson single-plane method, mean atrioventricular plane displacement (AVPDm), septal tissue velocity imaging (TDIs), and velocity time integral in the left ventricular outflow tract (VTI).

    Results

    EBEF, AVPDm, TDIs, VTI, and the Simpson were obtained in 100%, 100%, 99%, 95% and 93%, respectively, of all possible examinations. The correlations between the Simpson and EBEF showed r values for all 7 days ranging from 0.79 to 0.95 (P < 0.01). the Simpson correlations with the other LV parameters showed substantial variation over time, with the poorest results seen for TDIs and AVPDm. The repeatability was best for VTI (interobserver coefficient of variation (CV) 4.8%, and intraobserver CV, 3.1%), and AVPDm (5.3% and 4.4%, respectively), and worst for the Simpson method (8.2% and 10.6%, respectively).

    Conclusions

    EBEF and AVPDm provided the best, and Simpson, the worst feasibility when assessing LV systolic function in a population of mechanically ventilated, hemodynamically unstable patients. Additionally, the Simpson showed the poorest repeatability. We suggest that EBEF can be used instead of single-plane Simpson when assessing LV ejection fraction in this category of patients. TDIs and AVPDm, as markers of longitudinal function of the LV, are not interchangeable with LV ejection fraction.

  • 5.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries2016In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 117, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Background

    As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care.

    Methods

    We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries.

    Results

    A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2–7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries.

    Conclusions

    Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care.

  • 6.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care2012In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 12, no 25Article in journal (Refereed)
    Abstract [en]

    Background

    Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock.

    Methods

    A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP), high-sensitive troponin T (hsTNT) and transthoracic echocardiography (TTE) were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF), mean atrioventricular plane displacement (AVPDm), peak systolic tissue Doppler velocity imaging (TDIs) and velocity time integral in the LV outflow tract (LVOT VTI). LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time), tissue Doppler indices (é, á, E/é) and left atrial volume (La volume). APACHE II (Acute Physiology and Chronic Health Evaluation) and SOFA (Sequential Organ Failure Assessment) scores were calculated.

    Results

    hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003). Other univariate predictors of mortality were APACHE II (p = 0.009), E/é (p = 0.023), SOFA (p = 0.024) and age (p = 0.031). Survivors and non-survivors did not differ regarding BNP (p = 0.26) or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18). Multivariable logistic regression analysis identified hsTNT (p = 0.010) as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5).

    Conclusions

    hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.

  • 7.
    Chew, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients2013In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 1, no 16Article in journal (Refereed)
    Abstract [en]

    Background

    Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome.

    Methods

    In a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality.

    Results

    MAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1–2, 4–6).

    Conclusions

    MAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.

  • 8.
    Chew, Michelle
    Operations- och intensivvårdskliniken, Hallands sjukhus, Halmstad.
    Snabb behandling vid septisk chock räddar liv: Även om "early goal-directed therapy"-protokoll inte ger effekt i nya studier2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 112, p. 1-2, article id DFUCArticle in journal (Other academic)
  • 9.
    CHEW, Michelle
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions A statement from the ESA-ESICM joint taskforce on perioperative outcome measures2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 3, p. 88-105Article in journal (Refereed)
    Abstract [en]

    There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.

  • 10.
    Chew, Michelle
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Dalesjö, Lina
    Hallands Hosp Halmstad, Sweden.
    Life-threatening ketoacidosis in a lactating woman2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 12, p. 984-986Article in journal (Other academic)
    Abstract [en]

    n/a

  • 11.
    Chew, Michelle
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Rehn, Marius
    Oslo Univ Hosp, Norway; Norwegian Air Ambulance Fdn, Norway; Univ Stavanger, Norway.
    Olkkola, Klaus T.
    Univ Helsinki, Finland; Helsinki Univ Hosp, Finland.
    Sverrisson, Kristinn Orn
    Landspitali Univ Hosp, Iceland.
    Yli-Hankala, Arvi
    Tampere Univ Hosp, Finland; Univ Tampere, Finland.
    Moller, Morten Hylander
    Rigshosp, Denmark.
    Clinical practice guideline on prevention of rhabdomyolysis induced acute kidney injury: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article, review/survey (Refereed)
    Abstract [en]

    The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the recent DASAIM/DSIT guideline for prevention of rhabdomyolysis-induced acute kidney injury. However, we emphasize the low quality of evidence with only weak recommendations for all interventions, highlighting that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimates.

  • 12.
    Chew, Michelle S
    et al.
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Mangelus, Claes
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful – but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Refereed)
  • 13.
    Chew, Michelle S
    et al.
    Department of Anaesthesia and Intensive Care, Hallands sjukhus Halmstad.
    Mangelus, Claes
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful--but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register.2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Other academic)
  • 14.
    Chew, Michelle S
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walder, Bernhard
    University Hospital Geneva, Switzerland.
    Improving perioperative outcome: time to update protocols2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 4, p. 185-188Article in journal (Other academic)
    Abstract [en]

    n/a

  • 15.
    De Hert, Stefan
    et al.
    Univ Ghent, Belgium.
    Staender, Sven
    Reg Hosp Mannedorf Zurich, Switzerland; Paracelsus Med Univ Salzburg, Austria.
    Fritsch, Gerhard
    Paracelsus Med Univ Salzburg, Austria; AUVA Traumactr Vienna, Austria.
    Hinkelbein, Jochen
    Univ Hosp Cologne, Germany.
    Afshari, Arash
    Univ Copenhagen, Denmark.
    Bettelli, Gabriella
    Univ San Marino, San Marino.
    Bock, Matthias
    Paracelsus Med Univ Salzburg, Austria; Merano Hosp Franz Tappeiner, Italy.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Coburn, Mark
    Rhein Westfal TH Aachen, Germany.
    De Robertis, Edoardo
    Univ Naples Federico II, Italy.
    Drinhaus, Hendrik
    Univ Hosp Cologne, Germany.
    Feldheiser, Aarne
    Charite Univ Med Berlin, Germany.
    Geldner, Gotz
    RKH Klinikum Ludwigsburg, Germany.
    Lahner, Daniel
    AUVA Traumactr Vienna, Austria; Ludwig Boltzmann Inst Expt and Clin Traumatol, Austria.
    Macas, Andrius
    Lithuanian Univ Hlth Sci, Lithuania.
    Neuhaus, Christopher
    Univ Hosp Heidelberg, Germany.
    Rauch, Simon
    Merano Hosp Franz Tappeiner, Italy; EURAC Res, Italy.
    Santos-Ampuero, Maria Angeles
    Hosp Schwyz, Switzerland.
    Solca, Maurizio
    Danube Univ Krems, Austria.
    Tanha, Nima
    Not Found:Linkoping Univ, Linkoping Univ Hosp, Dept Anaesthesia and Intens Care, Linkoping, Sweden; Linkoping Univ, Linkoping Univ Hosp, Dept Med and Hlth Sci, Linkoping, Sweden.
    Traskaite, Vilma
    Lithuanian Univ Hlth Sci, Lithuania.
    Wagner, Gernot
    Danube Univ Krems, Austria.
    Wappler, Frank
    Univ Witten Herdecke, Germany.
    Pre-operative evaluation of adults undergoing elective noncardiac surgery Updated guideline from the European Society of Anaesthesiology2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 6, p. 407-465Article in journal (Refereed)
    Abstract [en]

    The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.

  • 16.
    Dessap, Armand Mekontso
    et al.
    Hop Univ Henri Mondor, France; Univ Paris Est Creteil, France.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Cardiac tamponade2018In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, no 6, p. 936-939Article in journal (Other academic)
    Abstract [en]

    n/a

  • 17.
    Dhanani, Jayesh A
    et al.
    Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia. jadhanani@hotmail.com; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia. jadhanani@hotmail.com; Critical Care Research Group, The University of Queensland, Brisbane, Australia.
    Cohen, Jeremy
    Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Parker, Suzanne L
    Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
    Chan, Hak-Kim
    Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
    Tang, Patricia
    Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
    Ahern, Benjamin J
    Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, Australia.
    Khan, Adeel
    Faculty of Science, School of Veterinary Science, The University of Queensland, Gatton, Australia.
    Bhatt, Manoj
    Department of Nuclear Medicine and Specialised PET Services Queensland, Royal Brisbane and Womens Hospital, Herston, Queensland, Australia; School of Medicine, Faculty of Health Sciences, University of Queensland, St Lucia, Queensland, Australia.
    Goodman, Steven
    Department of Nuclear Medicine and Specialised PET Services Queensland, Royal Brisbane and Womens Hospital, Herston, Queensland, Australia.
    Diab, Sara
    Critical Care Research Group, The University of Queensland, Brisbane, Australia.
    Chaudhary, Jivesh
    Critical Care Research Group, The University of Queensland, Brisbane, Australia.
    Lipman, Jeffrey
    Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia.
    Wallis, Steven C
    Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
    Barnett, Adrian
    Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia.
    Chew, Michelle S
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Fraser, John F
    Critical Care Research Group, The University of Queensland, Brisbane, Australia.
    Roberts, Jason A
    Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia; Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    A research pathway for the study of the delivery and disposition of nebulised antibiotics: an incremental approach from in vitro to large animal models2018In: Intensive Care Medicine Experimental, ISSN 1646-2335, E-ISSN 2197-425X, Vol. 6, no 1, article id 17Article in journal (Refereed)
    Abstract [en]

    Nebulised antibiotics are frequently used for the prevention or treatment of ventilator-associated pneumonia. Many factors may influence pulmonary drug concentrations with inaccurate dosing schedules potentially leading to therapeutic failure and/or the emergence of antibiotic resistance. We describe a research pathway for studying the pharmacokinetics of a nebulised antibiotic during mechanical ventilation using in vitro methods and ovine models, using tobramycin as the study antibiotic.

  • 18.
    Dhanani, Jayesh A.
    et al.
    Univ Queensland, Australia; Royal Brisbane and Womens Hosp, Australia.
    Diab, Sara
    Univ Queensland, Australia.
    Chaudhary, Jivesh
    Univ Queensland, Australia.
    Cohen, Jeremy
    Univ Queensland, Australia; Royal Brisbane and Womens Hosp, Australia.
    Parker, Suzanne L.
    Univ Queensland, Australia.
    Wallis, Steven C.
    Univ Queensland, Australia.
    Boidin, Clement
    Univ Queensland, Australia; Civil Hosp Lyon, France; Claude Bernard Univ Lyon 1, France.
    Barnett, Adrian
    Queensland Univ Technol, Australia; Queensland Univ Technol, Australia.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Roberts, Jason A.
    Univ Queensland, Australia; Royal Brisbane and Womens Hosp, Australia; Royal Brisbane and Womens Hosp, Australia.
    Fraser, John F.
    Univ Queensland, Australia.
    Lung Pharmacokinetics of Tobramycin by Intravenous and Nebulized Dosing in a Mechanically Ventilated Healthy Ovine Model2019In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, no 2, p. 344-355Article in journal (Refereed)
    Abstract [en]

    Editors PerspectiveWhat We Already Know about This Topic For most bacterial pneumonia, the lung interstitium is considered to be the site of infection, and adequate antibiotic concentrations are important for drug effect Despite systemic antibiotic therapy, therapeutic failure is common, perhaps due to poor lung penetration, and resulting low interstitial space fluid antibiotic concentrations Increasing systemic antibiotic doses in order to increase interstitial space fluid antibiotic concentrations could lead to toxicities such as nephrotoxicity What This Article Tells Us That Is New In a mechanically ventilated healthy large animal model, nebulized tobramycin produced higher peak lung interstitial space fluid concentrations, as well as higher initial epithelial lining fluid concentrations, with lower plasma concentrations than were observed after intravenous administration due to more extensive lung penetration Background: Nebulized antibiotics may be used to treat ventilator-associated pneumonia. In previous pharmacokinetic studies, lung interstitial space fluid concentrations have never been reported. The aim of the study was to compare intravenous and nebulized tobramycin concentrations in the lung interstitial space fluid, epithelial lining fluid, and plasma in mechanically ventilated sheep with healthy lungs. Methods: Ten anesthetized and mechanically ventilated healthy ewes underwent surgical insertion of microdialysis catheters in upper and lower lobes of both lungs and the jugular vein. Five ewes were given intravenous tobramycin 400 mg, and five were given nebulized tobramycin 400 mg. Microdialysis samples were collected every 20 min for 8 h. Bronchoalveolar lavage was performed at 1 and 6 h. Results: The peak lung interstitial space fluid concentrations were lower with intravenous tobramycin 20.2 mg/l (interquartile range, 12 mg/l, 26.2 mg/l) versus the nebulized route 48.3 mg/l (interquartile range, 8.7 mg/l, 513 mg/l), P = 0.002. For nebulized tobramycin, the median epithelial lining fluid concentrations were higher than the interstitial space fluid concentrations at 1 h (1,637; interquartile range, 650, 1,781, vs. 16 mg/l, interquartile range, 7, 86, P amp;lt; 0.001) and 6 h (48, interquartile range, 17, 93, vs. 4 mg/l, interquartile range, 2, 9, P amp;lt; 0.001). For intravenous tobramycin, the median epithelial lining fluid concentrations were lower than the interstitial space fluid concentrations at 1 h (0.19, interquartile range, 0.11, 0.31, vs. 18.5 mg/l, interquartile range, 9.8, 23.4, P amp;lt; 0.001) and 6 h (0.34, interquartile range, 0.2, 0.48, vs. 3.2 mg/l, interquartile range, 0.9, 4.4, P amp;lt; 0.001). Conclusions: Compared with intravenous tobramycin, nebulized tobramycin achieved higher lung interstitial fluid and epithelial lining fluid concentrations without increasing systemic concentrations.

  • 19.
    Dhanani, Jayesh A
    et al.
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Parker, Suzanne L
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia.
    Lipman, Jeffrey
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia.
    Wallis, Steven C
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia.
    Cohen, Jeremy
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Fraser, John
    Critical Care Research Group, The University of Queensland, Brisbane, Australia.
    Barnett, Adrian
    Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia.
    Chew, Michelle S
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Roberts, Jason A
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia; School of Pharmacy, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Recovery rates of combination antibiotic therapy using in vitro microdialysis simulating in vivo conditions2018In: Journal of pharmaceutical analysis, ISSN 2214-0883, Vol. 8, no 6, p. 407-412Article in journal (Refereed)
    Abstract [en]

    Microdialysis is a technique used to measure the unbound antibiotic concentration in the interstitial spaces, the target site of action. In vitro recovery studies are essential to calibrating the microdialysis system for in vivo studies. The effect of a combination of antibiotics on recovery into microdialysate requires investigation. In vitro microdialysis recovery studies were conducted on a combination of vancomycin and tobramycin, in a simulated in vivo model. Comparison was made between recoveries for three different concentrations and three different perfusate flow rates. The overall relative recovery for vancomycin was lower than that of tobramycin. For tobramycin, a concentration of 20µg/mL and flow rate of 1.0µL/min had the best recovery. A concentration of 5.0µg/mL and flow rate of 1.0µL/min yielded maximal recovery for vancomycin. Large molecular size and higher protein binding resulted in lower relative recoveries for vancomycin. Perfusate flow rates and drug concentrations affected the relative recovery when a combination of vancomycin and tobramycin was tested. Low perfusate flow rates were associated with higher recovery rates. For combination antibiotic measurement which includes agents that are highly protein bound, in vitro studies performed prior to in vivo studies may ensure the reliable measurement of unbound concentrations.

  • 20.
    Fagerström, Johan
    et al.
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    Bång, Magnus
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Wilhelms, Daniel
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    LiSep LSTM: A Machine Learning Algorithm for Early Detection of Septic Shock2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 15132Article in journal (Refereed)
    Abstract [en]

    Sepsis is a major health concern with global estimates of 31.5 million cases per year. Case fatality rates are still unacceptably high, and early detection and treatment is vital since it significantly reduces mortality rates for this condition. Appropriately designed automated detection tools have the potential to reduce the morbidity and mortality of sepsis by providing early and accurate identification of patients who are at risk of developing sepsis. In this paper, we present "LiSep LSTM"; a Long Short-Term Memory neural network designed for early identification of septic shock. LSTM networks are typically well-suited for detecting long-term dependencies in time series data. LiSep LSTM was developed using the machine learning framework Keras with a Google TensorFlow back end. The model was trained with data from the Medical Information Mart for Intensive Care database which contains vital signs, laboratory data, and journal entries from approximately 59,000 ICU patients. We show that LiSep LSTM can outperform a less complex model, using the same features and targets, with an AUROC 0.8306 (95% confidence interval: 0.8236, 0.8376) and median offsets between prediction and septic shock onset up to 40 hours (interquartile range, 20 to 135 hours). Moreover, we discuss how our classifier performs at specific offsets before septic shock onset, and compare it with five state-of-the-art machine learning algorithms for early detection of sepsis.

  • 21.
    Gillies, Michael A.
    et al.
    Royal Infirm Edinburgh NHS Trust, Scotland.
    Pearse, Rupert
    Royal London Hosp, England.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Peri-operative goal-directed therapy A definitive answer remains elusive2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 7, p. 467-468Article in journal (Other academic)
    Abstract [en]

    n/a

  • 22.
    Humble, Caroline A. S.
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Huang, Stephen
    Univ Sydney, Australia.
    Jammer, Ib
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Bjork, Jonas
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Prognostic performance of preoperative cardiac troponin and perioperative changes in cardiac troponin for the prediction of major adverse cardiac events and mortality in noncardiac surgery: A systematic review and meta-analysis2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0215094Article, review/survey (Refereed)
    Abstract [en]

    Background Increased postoperative cardiac troponin (cTn) independently predicts short-term mortality. Previous studies suggest that preoperative cTn also predicts major adverse cardiovascular events (MACE) and mortality after noncardiac surgery. The value of preoperative and perioperative changes in cTn as a prognostic tool for adverse outcomes has been sparsely investigated. Methods and findings A systematic review and meta-analysis of the prognostic value of cTns for adverse outcome was conducted. Adverse outcome was defined as short-term (in-hospital or amp;lt; 30 days) and long-term (amp;gt; 30 days) MACE and/or all-cause mortality, in adult patients undergoing noncardiac surgery. The study protocol (CRD42018094773) was registered with an international prospective register of systematic reviews (PROSPERO). Preoperative cTn was a predictor of short-(OR 4.3, 95% CI 2.9-6.5, pamp;lt;0.001, adjusted OR 5.87, 95% CI 3.24-10.65, pamp;lt;0.001) and long-term adverse outcome (OR 4.2, 95% CI 1.0-17.3, p=0.05, adjusted HR 2.0, 95% CI 1.4-3.0, pamp;lt;0.001). Perioperative change in cTn was a predictor of short-term adverse outcome (OR 10.1, 95% CI 3.2-32.3, pamp;lt;0.001). It was not possible to conduct pooled analyses for adjusted estimates of perioperative change in cTn as predictor of short (a single study identified) and long-term (no studies identified) adverse outcome. Further, it was not possible to conduct pooled analyses for unadjusted estimates of perioperative change in cTn as predictor of long-term adverse outcome, since only one study was identified. Bivariate analysis of sensitivities and specificities were performed, and overall prognostic performance was summarized using summary receiver operating characteristic (SROC) curves. The pooled sensitivity and specificity for preoperative cTn and short-term adverse outcome was 0.43 and 0.86 respectively (area under the SROC curve of 0.68). There were insufficient studies to construct SROCs for perioperative changes in cTn and for long-term adverse outcome. Conclusion Our study indicates that although preoperative cTn and perioperative change in cTn might be valuable predictors of MACE and/or all-cause mortality in adult noncardiac surgical patients, its overall prognostic performance remains uncertain. Future large, representative, high-quality studies are needed to establish the potential role of cTns in perioperative cardiac risk stratification.

  • 23.
    Jammer, Ib
    et al.
    Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Anaesthesia and Intensive Care, Haukeland University Hospital,.
    Wickboldt, Nadine
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Sander, Michael
    Department of Anaesthesia and Intensive Care, Charite, Berlin, Germany.
    Smith, Andrew
    Royal Lancaster Infirmary, Lancaster University, Lancaster, UK.
    Schultz, Marcus J
    Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
    Pelosi, Paolo
    Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital,University of Genoa, Genoa, Italy.
    Leva, Brigitte
    European Society of Anaesthesiology, Brussels, Belgium.
    Rhodes, Andrew
    Critical Care, St George’s Hospital, London, UK.
    Hoeft, Andreas
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany .
    Walder, Bernhard
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Chew, Michelle S
    Department of Anaesthesia and Intensive Care Medicine, Hallands Sjukhus, Halmstad, Sweden Institute of Clinical Sciences, Lund University, Sweden.
    Pearse, Rupert M
    Queen Mary University of London, London, UK.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 2, p. 88-105Article in journal (Refereed)
    Abstract [en]

    There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.

  • 24.
    Jawad, Monir
    et al.
    Department of Anaesthesiology and Intensive Care, Central Hospital in Kristianstad, Kristianstad, Sweden.
    Baigi, Amir
    Department of Primary Healthcare, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Oldner, Anders
    Department of Anaesthesiology, Karolinska University Hospital and Institute, Surgical Services and Intensive Care, Stockholm, Sweden.
    Pearse, Rupert M
    Queen Mary University of London and Adult Critical Care Unit, Royal London Hospital, London, UK.
    Rhodes, Andrew
    Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London, UK.
    Seeman-Lodding, Helen
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Chew, Michelle S
    Institute of Clinical Sciences Malmö, Lund University, Lund and the Department of Anaesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden.
    Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery.2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 5, p. 317-325Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The European Surgical Outcomes Study (EuSOS) revealed large variations in outcomes among countries. In-hospital mortality and ICU admission rates in Sweden were low, going against the assumption that access to ICU improves outcome. Long-term mortality was not reported in EuSOS and is generally poorly described in the current literature.

    OBJECTIVE: To describe the characteristics of the Swedish subset of EuSOS and identify predictors of short and long-term mortality after surgery.

    DESIGN: An observational cohort study.

    SETTING: Six universities and two regional hospitals in Sweden.

    PATIENTS: A cohort of 1314 adult patients scheduled for surgery between 4 April and 11 April 2011.

    MAIN OUTCOME MEASURES: 30-day and 1-year mortality.

    RESULTS: A total of 303 patients were lost to follow-up, leaving 1011 for analysis; 69% of patients were classified as American Society of Anesthesiologists' physical status 1 or 2, and 68% of surgical procedures were elective. The median length of stay in postanaesthesia care units (PACUs) was 175 min (interquartile range 110-270); 6.6% of patients had PACU length of stay of more than 12 h and 3.6% of patients were admitted to the ICU postoperatively. Thirty-day mortality rate was 1.8% [95% confidence interval (CI) 1.0-2.6] and 8.5% (CI 6.8-10.2) at 1 year (n = 18 and 86). The risk of death was higher than in an age and sex-matched population after 30 days (standardised mortality ratio 10.0, CI 5.9-15.8), and remained high after 1 year (standardised mortality ratio 3.9, CI 3.1-4.8). Factors predictive of 30-day mortality were age, American Society of Anesthesiologists' physical status, number of comorbidities, urgency of surgery and ICU admission. For 1-year mortality, age, number of comorbidities and urgency of surgery were independently predictive. ICU admission and long stay in PACU were not significant predictors of long-term mortality.

    CONCLUSION: Mortality rate increased almost five-fold at 1 year compared with 30-day mortality after surgery, demonstrating a significantly sustained long-term risk of death in this surgical population. In Sweden, factors associated with long-term postoperative mortality were age, number of comorbidities and surgical urgency.

  • 25.
    Kollind, M.
    et al.
    Centalsjukhuset Kristianstad, Sweden.
    Wickbom, F.
    Hallands Sjukhus, Sweden.
    Wilkman, E.
    University of Helsinki, Finland.
    Snackestrand, M. S. C.
    Sahlgrenska University Hospital, Sweden.
    Holmen, A.
    Regional Halland, Sweden.
    Oldner, A.
    Karolinska University Hospital, Sweden.
    Perner, A.
    Rigshosp, Denmark.
    Aneman, A.
    University of New South Wales, Australia.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Shock treatment in a cohort of Scandinavian intensive care units in 20142016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 7, p. 945-957Article in journal (Refereed)
    Abstract [en]

    BackgroundShock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units. MethodsSeven-day inception cohort study in 43 intensive care units in Scandinavia. Patients 15years old receiving more than 4h of cardiovascular acting drug infusion were included. The use of fluids, vasopressor and inotropic drugs, type of monitoring, and target values were recorded. ResultsOne hundred and seventy-one patients were included. At inclusion, 136/168 (81%) had received vasopressor and/or inotropic drug therapy for less than 24h, and 143/171 (84%) had received volume loading before the onset of vasoactive drug treatment. Ringers solution was given to 129/143 (90%) of patients and starches in 3/143 (2%) patients. Noradrenaline was the most commonly used cardiovascular acting drug, given in 168/171 (98%) of cases while dopamine was rarely used. Mean arterial pressure was considered the most important variable for hemodynamic monitoring. Invasive arterial blood pressure was monitored in 166/171 (97%) of patients, arterial pulse wave analysis in 11/171 (7%), and echocardiography in 50/171 (29%). ConclusionIn this survey, Ringers solution and noradrenaline were the most common first-line treatments in shock. The use of starches and dopamine were rare. Almost all patients were monitored with invasive arterial blood pressure, but comprehensive hemodynamic monitoring was used only in a minority of patients.

  • 26.
    Kreu, Simon
    et al.
    Lund University, Sweden; Örebro University Hospital, Sweden.
    Jazrawi, Allan
    Lund University, Sweden; Västmanland County Hospital, Sweden.
    Miller, Jan
    Lund University, Sweden.
    Baigi, Amir
    Gothenburg University, Sweden.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Lund University, Sweden.
    Alkalosis in Critically III Patients with Severe Sepsis and Septic Shock2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0168563Article in journal (Refereed)
    Abstract [en]

    Introduction Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock. Methods This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. We investigated the relationship between metabolic alkalosis and mortality. Further, we studied the relationship between metabolic alkalosis and ICU length of stay (LOS). Results Metabolic alkalosis was associated with decreased 30-day and 12-month mortalities. This effect was however lost when a multivariate analysis was conducted, correcting for age, gender, pH on admission, base excess (BE) on admission, Simplified Acute Physiology Score III (SAPS III) and acute kidney injury (AKI). We then analyzed for any dose-response effect between the severity of metabolic alkalosis and mortality and found no relationship. Bivariate analysis showed that metabolic alkalosis had a significant effect on the length of ICU stay. When adjusting for age, sex, pH at admission, BE at admission, SAPS III and AKI in a multivariate analysis, metabolic alkalosis significantly contributed to prolonged ICU length of stay. In two separate sensitivity analyses pure metabolic alkalosis and late metabolic alkalosis (time of onset amp;gt; 48 hours) were the only significant predictor of increased ICU length of stay. Conclusion Metabolic alkalosis did not have any effect on 30-day and 12-month mortalities after adjusting for age, sex, SAPS III-score, pH and BE on admission and AKI in a multivariate analysis. The presence of metabolic alkalosis was independently associated with an increased ICU length of stay.

  • 27.
    Laake, J. H.
    et al.
    Oslo Univ Hosp, Norway.
    Tonnessen, T. I.
    Oslo Univ Hosp, Norway.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Lipcsey, M.
    Uppsala Univ Hosp, Sweden.
    Hjelmqvist, H.
    Orebro Univ, Sweden; Univ Hosp, Sweden.
    Wilkman, E.
    Helsinki Univ Hosp, Finland.
    Pettilae, V.
    Univ Helsinki, Finland; Helsinki Univ Hosp, Finland.
    Hoffmann-Petersen, J.
    Odense Univ Hosp, Denmark.
    Moller, M. H.
    Copenhagen Univ Hosp, Denmark.
    The SSAI fully supports the suspension of hydroxyethyl-starch solutions commissioned by the European Medicines Agency2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 6, p. 874-875Article in journal (Other academic)
    Abstract [en]

    n/a

  • 28.
    Lundberg, Oscar H. M.
    et al.
    Skåne University Hospital Malmö, Sweden.
    Bergenzaun, Lill
    Skåne University Hospital Malmö, Sweden.
    Ryden, Jorgen
    Skåne University Hospital Malmö, Sweden.
    Rosenqvist, Mari
    Skåne University Hospital Malmö, Sweden.
    Melander, Olle
    Skåne University Hospital Malmö, Sweden; Lund University, Sweden.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Lund University, Sweden.
    Adrenomedullin and endothelin-1 are associated with myocardial injury and death in septic shock patients2016In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 20, no 178Article in journal (Refereed)
    Abstract [en]

    Background: Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality. Methods: A cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated. Results: Levels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold. Conclusions: MR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.

  • 29.
    Lyckner, S.
    et al.
    Malarsjukhuset, Sweden.
    Boregard, I. -L.
    Sodertalje Hosp AB, Sweden.
    Zetterlund, E. -L.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Validation of the Swedish version of Quality of Recovery score-15: a multicentre, cohort study2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 7, p. 893-902Article in journal (Refereed)
    Abstract [en]

    BackgroundQuality of recovery (QoR) after surgery is often focused on morbidity, mortality and physiological changes, while well-being and emotional state are other important aspects that are often ignored. QoR is poorly investigated in clinical settings and a psychometrically tested questionnaire, QoR-15, has recently been developed. QoR-15 has not been validated for Swedish conditions. The aim of this study was to translate, adapt and validate QoR-15 to Swedish conditions (QoR-15swe). MethodsA translation and cultural adaption was performed resulting in a Swedish version of the instrument, QoR-15swe. Patients answered the QoR-15swe before surgery, 24 and 48h after surgery. Feasibility, validity, reliability and responsiveness of the QoR-15swe were evaluated. ResultsThe QoR-15swe was feasible in 85.5% of the eligible patients. Construct validity was good, with significant correlations between QoR-15swe score and, ASA-PS class, grade of surgery, length of surgery and time in the post-anaesthesia care unit. The instrument demonstrated good internal consistency with an inter-item Cronbachs of 0.83-0.87, and inter-dimension Cronbachs was acceptable 0.71-0.76. Test-retest repeatability was also good with Cronbachs alpha amp;gt;0.99 and an interclass correlation coefficient of 0.992 (CI: 0.981-0.997). There were no floor and ceiling effects. Responsiveness assessed by Cliffs effect size was -0.23 indicating a moderate ability to detect change at 24h postoperatively. ConclusionWe have translated and culturally adapted the QoR-15 into Swedish. The score demonstrated acceptable validity, reliability and responsiveness. The QoR-15swe is a clinically acceptable and feasible outcome measure after surgery in a Swedish population.

  • 30.
    McLean, Anthony S.
    et al.
    Univ Sydney, Australia.
    Slama, Michel
    CHU Sud, France.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Does this patient have takotsubo syndrome?2018In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, no 6, p. 904-907Article in journal (Other academic)
    Abstract [en]

    n/a

  • 31.
    Navarro, Lais H.
    et al.
    Botucatu Medical School, UNESP, Botucatu, Sao Paulo, Brazil (LHN.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Postoperative acute kidney injury A never-ending challenge2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 9, p. 639-640Article in journal (Other academic)
  • 32.
    Rehn, Marius
    et al.
    Oslo Univ Hosp, Norway; Norwegian Air Ambulance Fdn, Norway; Univ Stavanger, Norway.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Olkkola, Klaus T.
    Univ Helsinki, Finland; Helsinki Univ Hosp, Finland.
    Sverrison, Kristinn O.
    Landspitali Univ Hosp, Iceland.
    Yli-Hankala, Arvi
    Tampere Univ Hosp, Finland; Univ Tampere, Finland.
    Moller, Morten Hylander
    Copenhagen Univ Hosp, Denmark.
    Clinical practice guideline on atraumatic (pencil-point) vs conventional needles for lumbar puncture: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 4, p. 438-439Article, review/survey (Refereed)
    Abstract [en]

    The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the BMJ Rapid Recommendation clinical practice guideline on atraumatic (pencil-point) vs conventional needles for lumbar puncture. This includes the strong recommendation for the use of atraumatic needles for lumbar puncture in all patients regardless of age or indication.

  • 33.
    Rehn, Marius
    et al.
    Oslo Univ Hosp, Norway; Norwegian Air Ambulance Fdn, Norway; Univ Stavanger, Norway.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Olkkola, Klaus T.
    Univ Helsinki, Finland; Helsinki Univ Hosp, Finland.
    Sverrison, Kristinn Orn
    Landspitali Univ Hosp, Iceland.
    Yli-Hankala, Arvi
    Tampere Univ Hosp, Finland; Univ Tampere, Finland.
    Moller, Morten Hylander
    Copenhagen Univ Hosp, Denmark.
    Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 2, p. 161-163Article, review/survey (Refereed)
    Abstract [en]

    Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement.

  • 34.
    Simon, Geoff I.
    et al.
    Univ Sunshine Coast, Australia.
    Craswell, Alison
    Univ Sunshine Coast, Australia.
    Thom, Ogilvie
    Sunshine Coast Univ Hosp, Australia.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Anstey, Chris M.
    Sunshine Coast Univ Hosp, Australia; Univ Queensland, Australia; Griffith Univ, Australia.
    Fung, Yoke Lin
    Univ Sunshine Coast, Australia.
    Impacts of Aging on Anemia Tolerance, Transfusion Thresholds, and Patient Blood Management2019In: Transfusion Medicine Reviews, ISSN 0887-7963, E-ISSN 1532-9496, Vol. 33, no 3, p. 154-161Article, review/survey (Refereed)
    Abstract [en]

    Evidence-based patient blood management guidelines commonly recommend restrictive hemoglobin thresholds of 70 to 80 g/L for asymptomatic adults. However, most transfusion trials have enrolled adults across a broad age span, with few exclusive to older adults. Our recent meta-analysis of transfusion trials that focused on older adults paradoxically found lower mortality and fewer cardiac complications when these patients were managed using higher hemoglobin thresholds. We postulate that declining cardiac output with age contributes to deteriorating oxygen delivery capacity which impacts anemia-associated outcomes in older adults and propose a model to explain this age-related difference. We reviewed evidence concerning the pathophysiology of aging to explore the disparity in transfusion trial outcomes related to hemoglobin thresholds in different age groups. The literature was searched for normative cardiac output values at different ages in healthy adults. Using normative peak cardiac output data, we modeled oxygen delivery capacity in young, middle-aged, and older adults at a range of hemoglobin levels. Cardiovascular and pulmonary systems are impacted by age-related pathophysiological changes. Diminishing peak cardiac output associated with aging reduces the maximal oxygen delivery achievable under metabolic stress. Hence, at low hemoglobin levels, older adults are more susceptible to tissue hypoxia than younger adults. Our model predicts that an older adult with a hemoglobin of 100 g/L has a similar peak oxygen delivery capacity to a young adult with a hemoglobin of 70 g/L. Age-related pathophysiological changes provide some explanation as to why older adults have a lower tolerance for anemia than younger adults. This indicates the need for patient blood management hemoglobin thresholds specific to older as distinct from younger adults. The primary application of this model is in the consideration of patients rehabilitating to life outside hospital. It is important to note that pathophysiological changes associated with critical illness and major surgery are more complex than can be described in a simple model based on cardiac output and hemoglobin concentration. However, our review of oxygen transport and delivery in health and disease states allows the model to be considered in the context of treatment decisions for anemic adults in a range of hospital and community settings. (C) 2019 Elsevier Inc. All rights reserved.

  • 35.
    Snygg, Johan
    et al.
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Anaesthesiol & Intens Care, Gothenburg, Sweden, Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden.
    Andersson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Fredrikson, Mats
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Chew, Michelle S
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Nordström, Rasmus (Contributor)
    Region Östergötland.
    Linhardt, Michael (Contributor)
    Region Östergötland.
    de Geer, Lina (Contributor)
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland.
    Myocardial injury in noncardiac surgery in Sweden: Study protocol for a multicentre, observational cohort study of patients undergoing elective, major abdominal surgery2019In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 5, p. 383-385Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 36.
    Toft, Palle
    et al.
    Department Anaesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK - 5000 Odense C, Denmark .
    Olsen, Hanne Tanghus
    Department Anaesthesiology and Intensive Care, Svendborg Hospital, Valdemarsgade 5 5700 Svendborg, Denmark, .
    Jørgensen, Helene Korvenius
    Department Anaesthesiology and Intensive Care, Hospital Lillebaelt, Skovvangen 2-8, 6000 Kolding, Denmark .
    Strøm, Thomas
    Department Anaesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK - 5000 Odense C, Denmark .
    Nibro, Helle Lykkeskov
    Department Anaesthesiology and Intensive Care, Aarhus University Hospital Nørrebrogade 44, 8000 Aarhus, Denmark .
    Oxlund, Jacob
    Department Anaesthesiology and Intensive Care, Esbjerg Hospital, Frihedsvej 15, 6700 Esbjerg, Denmark .
    Wian, Karl-Andre
    Department Anaesthesiology and Intensive Care, Vestfold Hospital, Halfdan Wilhelmsens alle 17, 3116 Tonsberg, Norway. .
    Ytrebø, Lars Marius
    Department Anaesthesiology and Intensive Care, University Hospital of North Norway .
    Kroken, Bjørn Anders
    Department Anaesthesiology and Intensive Care, University Hospital of North Norway .
    Chew, Michelle
    8Department Anaesthesiology and Intensive Care, Hallands Hospital, Lasarettsvägen, 302 33 Halmstad, Sweden. .
    Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation (NONSEDA Trial): study protocol for a randomised controlled trial2014In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 15, no 499, p. 1-11Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Through many years, the standard care has been to use continuous sedation of critically ill patients during mechanical ventilation. However, preliminary randomised clinical trials indicate that it is beneficial to reduce the sedation level. No randomised trial has been conducted comparing sedation with no sedation, a priori powered to have all-cause mortality as primary outcome.The objective is to assess the benefits and harms of non-sedation versus sedation with a daily wake-up trial in critically ill patients.

    METHODS/DESIGN: The non-sedation (NONSEDA) trial is an investigator-initiated, randomised, clinical, parallel-group, multinational trial designed to include 700 patients from at least six ICUs in Denmark, Norway and Sweden.Inclusion criteria are mechanically ventilated patients with expected duration of mechanical ventilation >24 hours.Exclusion criteria are non-intubated patients, patients with severe head trauma, coma at admission or status epilepticus, patients treated with therapeutic hypothermia, patients with PaO2/FiO2 < 9 where sedation might be necessary to ensure sufficient oxygenation or place the patient in prone position.Experimental intervention is non-sedation supplemented with pain management during mechanical ventilation.Control intervention is sedation with a daily wake-up trial.The primary outcome will be all cause mortality at 90 days after randomization. Secondary outcomes will be: days until death throughout the total observation period; coma- and delirium-free days; highest RIFLE score; days until discharge from the intensive care unit (within 28 days); days until the participant is without mechanical ventilation (within 28 days); and proportion of patients with a major cardiovascular outcome. Explorative outcomes will be: all cause mortality at 28 days after randomisation; days until discharge from the intensive care unit; days until the participant is without mechanical ventilation; days until discharge from the hospital; organ failure.Trial size: we will include 700 participants (2 × 350) in order to detect or reject 25% relative risk reduction in mortality with a type I error risk of 5% and a type II error risk of 20% (power at 80%).

    DISCUSSION: The trial investigates potential benefits of non-sedation. This might have large impact on the future treatment of mechanically ventilated critically ill patients.

    TRIAL REGISTER: ClinicalTrials.gov NCT0196768, 09.01.2014.

  • 37.
    Vieillard-Baron, Antoine
    et al.
    Univ Hosp Ambroise Pare, France; Univ Versailles St Quentin En Yvelines, France.
    Millington, S. J.
    Univ Ottawa, Canada.
    Sanfilippo, F.
    Policlin Vittorio Emanuele Univ Hosp, Italy.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Diaz-Gomez, J.
    Mayo Clin, FL 32224 USA.
    McLean, A.
    Univ Sydney, Australia.
    Pinsky, M. R.
    Univ Pittsburgh, PA USA.
    Pulido, J.
    US Anesthesia Partners, WA USA.
    Mayo, P.
    Northwell Hlth LIJ NSUH Med Ctr, NY USA.
    Fletcher, N.
    St Georges Univ London, England; Cleveland Clin London, England.
    A decade of progress in critical care echocardiography: a narrative review2019In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 45, no 6, p. 770-788Article, review/survey (Refereed)
    Abstract [en]

    IntroductionThis narrative review focusing on critical care echocardiography (CCE) has been written by a group of experts in the field, with the aim of outlining the state of the art in CCE in the 10 years after its official recognition and definition.ResultsIn the last 10years, CCE has become an essential branch of critical care ultrasonography and has gained general acceptance. Its use, both as a diagnostic tool and for hemodynamic monitoring, has increased markedly, influencing contemporary cardiorespiratory management. Recent studies suggest that the use of CCE may have a positive impact on outcomes. CCE may be used in critically ill patients in many different clinical situations, both in their early evaluation of in the emergency department and during intensive care unit (ICU) admission and stay. CCE has also proven its utility in perioperative settings, as well as in the management of mechanical circulatory support. CCE may be performed with very simple diagnostic objectives. This application, referred to as basic CCE, does not require a high level of training. Advanced CCE, on the other hand, uses ultrasonography for full evaluation of cardiac function and hemodynamics, and requires extensive training, with formal certification now available. Indeed, recent years have seen the creation of worldwide certification in advanced CCE. While transthoracic CCE remains the most commonly used method, the transesophageal route has gained importance, particularly for intubated and ventilated patients.ConclusionCCE is now widely accepted by the critical care community as a valuable tool in the ICU and emergency department, and in perioperative settings.

  • 38.
    Vieillard-Baron, Antoine
    et al.
    Univ Hosp Ambroise Pare, France; Univ Varsailles St Quentin Yvelines, France.
    Millington, S. J.
    Univ Ottawa, Canada.
    Sanfilippo, F.
    Policlin Vittorio Emanuele Univ Hosp, Italy.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Diaz-Gomez, J.
    Mayo Clin, FL 32224 USA.
    McLean, A.
    Univ Sydney, Australia.
    Pinsky, M. R.
    Univ Pittsburgh, PA USA.
    Pulido, J.
    Swedish Med Ctr, WA USA.
    Mayo, P.
    Zucker School of Medicine, New York, United States.
    Fletcher, N.
    St Georges Univ London, England; Cleveland Clin London, England.
    Correction: A decade of progress in critical care echocardiography: a narrative review (vol 45, pg 770, 2019)2019In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 45, no 6, p. 911-911, article id UNSP 911Article in journal (Refereed)
    Abstract [en]

    The original version of this article unfortunately contained a mistake.

  • 39.
    Wilhelms, Daniel
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, 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.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Emergency medicine is about collaboration, not monopolisation2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 231-232Article in journal (Other academic)
    Abstract [en]

    n/a

  • 40.
    Åhman, Rasmus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Forsberg Siverhall, Pontus
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Snygg, Johan
    Sahlgrens Univ Hosp, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Enlund, Gunnar
    Uppsala Univ Hosp, Sweden.
    Björnström, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Determinants of mortality after hip fracture surgery in Sweden: a registry-based retrospective cohort study2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 15695Article in journal (Refereed)
    Abstract [en]

    Surgery for hip fractures is associated with high mortality and morbidity. The causes of poor outcome are not fully understood and may be related to other factors than the surgery itself. The relative contributions of patient, surgical, anaesthetic and structural factors have seldom been studied together. This study, a retrospective registry-based cohort study of 14 932 patients undergoing hip fracture surgery in Sweden from 1st of January 2014 to 31st of December 2016, aimed to identify important predictors of mortality post-surgery. The independent predictive power of our included variables was examined using Cox proportional hazards modeling with all-cause mortality at longest follow-up as the outcome. Twelve independent variables were considered as interrelated exposures and their individual adjusted effect within a single model were evaluated. Kaplan-Meier curves were also generated. Crude mortality rates were 8.2% at 30 days (95% CI 7.7-8.6%) and 23.6% at 365 days (95% CI 22.9-24.2%). Of the 12 factors entered into the Cox regression analysis, age (aHR1.06, p amp;lt; 0.001), male gender (aHR 1.45, p amp;lt; 0.001), ASA-PS-class (ASA 1amp;2 reference; ASA 3 aHR 2.12; ASA 4 aHR 4.79; ASA 5 aHR 12.57 respectively, p amp;lt; 0.001) and PACU-LOS (aHR 1.01, p amp;lt; 0.001) were significantly associated with mortality at longest follow-up (up to 3 years). University hospital status was protective (aHR 0.83, p amp;lt; 0.001) in the same model. Age, gender and ASA-PS-class were strong predictors of mortality after surgery for hip fractures in Sweden. University hospital status and length of stay in the postoperative care unit were also identified as modifiable risk factors after multivariable adjustment and require confirmation in future studies.

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