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  • 1.
    Agvald-Ohman, C
    et al.
    Karolinska University.
    Struwe, J
    Karolinska Institute.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    PROMOTING INFECTION CONTROL IN THE ICU USING A TARGETED PUSH-AND-PULL INTERVENTION2009In: in INTENSIVE CARE MEDICINE, vol 35, 2009, Vol. 35, p. 176-176Conference paper (Refereed)
    Abstract [en]

    n/a

  • 2.
    Agvald-Öhman, Christina
    et al.
    Anestesioch intensivvårdskliniken, Karolinska universitetssjukhuset, Huddinge, CLINTEC, Karolinska institutet, Stockholm, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Struwe, Johan
    Strama och avdelningen för epidemiologi, Smittskyddsinstitutet, Stockholm, Sweden.
    Walther, Sten M.
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    »Skjut på« och »dra« metod för att minska vårdrelaterade infektioner på IVA: Pilotprojekt med aktiv uppföljning2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 1-2Article in journal (Refereed)
    Abstract [sv]

    Vårdrelaterade infektioner är ett särskilt stort problem inom intensivvården där patienterna är kritiskt sjuka och har många riskfaktorer.

    För att minska frekvensen vårdrelaterade infektioner måste ett strukturerat arbete bedrivas från flera olika utgångspunkter.

    Vi måste bli bättre på att dia­gnostisera, dokumentera och förebygga dessa infektioner.

    Kombinerad intervention av typen »push« och »pull« visade på lovande resultat med införande av bättre diagnostiska metoder och en upplevelse av ökad motivation hos personalen efter besöket.

  • 3. Ahlberg, M
    et al.
    Bäckman, Carl
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Jones, C
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Group communication confirm feelings among partners of former intensive care patients2014Conference paper (Other academic)
  • 4.
    Ahlberg, Mona
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Bäckman, Carl
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Jones, Christina
    Musculoskeletal Biology, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.
    Walther, Sten
    Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center.
    Moving on in life after intensive care - partners' experience of group communication2015In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 20, no 5, p. 256-263Article in journal (Refereed)
    Abstract [en]

    Background:Partners have a burdensome time during and after their partners’ intensive care period. They may appear to be coping welloutwardly but inside feel vulnerable and lost. Evaluated interventions for partners on this aspect are limited.

    Aim:The aim of this study was to describe the experience of participating in group communication with other partners of former intensivecare patients.

    Design:The study has a descriptive intervention-based design where group communication for partners of former, surviving intensive careunit (ICU) patients was evaluated.

    Methods:A strategic selection was made of adult partners to former adult intensive care patients (n=15), 5 men and 10 women, aged37–89 years. Two group communication sessions lasting 2 h were held at monthly intervals with three to five partners. The partners later wrote,in a notebook, about their feelings of participating in group communications. To deepen the understanding of the impact of the sessions, six ofthe partners were interviewed. Content analysis was used to analyse the notebooks and the interviews.

    Findings:Three categories were identified: (1) Emotional impact, the partners felt togetherness and experienced worries and gratitude, (2)Confirmation, consciousness through insight and reflection and (3) The meeting design, group constellation and recommendation to participatein group communication.

    Conclusion:Partners of an intensive care patient are on a journey, constantly trying to adapt to the new situation and find new strategiesto ever-changing circumstances. Group communications contributed to togetherness and confirmation. To share experiences with others is oneway for partners to be able to move forward in life.

    Relevance to clinical practice:Group communication with other patients’ partners eases the process of going through the burden ofbeing a partner to an intensive care patient. Group communications needs to be further developed and evaluated to obtain consensus andevidence for the best practice.

  • 5.
    Alvsaker, Kristin
    et al.
    University of Oslo.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Kleffelgard, Ingerid
    University of Oslo.
    Mongs, Malin
    University of Oslo.
    Aas Draegebo, Randi
    University of Oslo.
    Keller, Anne
    University of Oslo.
    INTER-RATER RELIABILITY OF THE EARLY FUNCTIONAL ABILITIES SCALE2011In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, no 10, p. 892-899Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the inter-rater reliability of the Early Functional Abilities (EFA) scale. less thanbrgreater than less thanbrgreater thanDesign: An observational study of inter-rater reliability in an open cohort. less thanbrgreater than less thanbrgreater thanPatients: Twenty-four patients with traumatic brain injury in need of medical or surgical intervention in the early rehabilitation section of the intensive care unit. less thanbrgreater than less thanbrgreater thanMethods: The EFA was assessed by 4 different professions in the rehabilitation team. Inter-rater reliability was assessed using linear weighted kappa statistics. less thanbrgreater than less thanbrgreater thanResults: The overall weighted kappa values of the different EFA items varied from 0.27 to 0.60. The items in the sensorimotor functional area had the highest pairwise agreement, with a mean kappa range of 0.68-0.76. The vegetative stability, position tolerance and wakefulness items had the lowest mean kappa values (0.49, 0.33 and 0.49, respectively). Agreement was good to excellent between the occupational therapist and physiotherapist across the majority of the items, whereas the physician and nurse agreed less with one another. less thanbrgreater than less thanbrgreater thanConclusion: The inter-rater reliability of the EFA scale was good for most items among all the raters. The scale may be used by all members of the interdisciplinary team after training in administration and scoring. A reduction in the number of items in the vegetative functional domain is recommended.

  • 6. Alvsåker, K
    et al.
    Kvandal, P
    Hanoa, R
    Olafsen, K
    Grömer, G
    Kleffelgård, I
    Mongs, M
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Tidlig rehabilitering av alvorlige traumatiske hoderskader ved en intensivavdeling. Erfaringer fra 2 års drift. En pilotstudie.2007In: Nasjonal konferanse om traumatisk hjerneskade,2007, 2007Conference paper (Refereed)
    Abstract [sv]

      

  • 7.
    Banck, M
    et al.
    Hallands Hospital, Halmstad, Sweden.
    Heller, Ute
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Samuelsson, C
    Hallands Hospital, Halmstad, Sweden.
    Wickerts, CJ
    Danderyd Hospital and Karolinska Institutet, Stockholm, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Women with out-of-hospital cardiac arrest are less likely to receive therapeutic hypothermia and more likely to die than men: Swedish nationwide cohort study2013Conference paper (Refereed)
  • 8.
    Banck, M
    et al.
    Svenska Intensivvårdsregistret, Karlstad.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Karlström, G
    Svenska Intensivvårdsregistret, Karlstad.
    Nolin, T
    Svenska Intensivvårdsregistret, Kristianstad.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Samuelsson, C
    Svenska Intensivvårdsregistret, Karlstad.
    Är svensk intensivvård könsjämlik?2013Conference paper (Refereed)
  • 9.
    Banck, Malin
    et al.
    Hallands sjukhus, Halmstad.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Karlström, Göran
    Centralsjukhuset, Karlstad.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Samuelsson, Carolina
    Hallands sjukhus, Halmstad.
    Män intensivvårdas mer än kvinnor: Med det är ändå oklart om intensivvården i Sverige är könsojämlik2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 9-10, p. 388-390Article in journal (Other academic)
  • 10. Berkius, J
    et al.
    Nolin, T
    Mårdh, C
    Karlström, G
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Respiratory failure due to acute on chronic obstructive pulmonary disease: an analysis of cases in the Swedish Intensive Care Registry during 2002-20062007In: in Intensive Care Medicine(ISSN 0342-4642), vol 33, 2007, Vol. 33, p. 15-15Conference paper (Refereed)
  • 11. Berkius, J
    et al.
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Predictors of immediate and delayed endotracheal intubation in acute on chronic obstructive pulmonary disease (COPD)2007In: in Acta anaesthesiologica Scandinavica. Supplementum, ISSN 0515-2720, vol 51, 2007, Vol. 51, p. 22-22Conference paper (Refereed)
  • 12. Berkius, J
    et al.
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vårdprogram för KOL behöver implementeras bättre: Intensivvård vid kroniskt obstruktiv lungsjukdom med andningssvikt - från evidens till praxis (Acute respiratory failure in chronic obstructive lung disease - from evidence to clinical practice)2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, p. 1897-1901Article in journal (Other academic)
    Abstract [en]

      

  • 13.
    Berkius, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Department of Anaesthesia and Intensive Care, Västervik County Hospital, Västervik, Sweden.
    Engerström, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Orwelius, Lotti
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nordlund, Peter
    Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping,.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten M
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences.
    A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD2013In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, p. R211-Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 14.
    Berkius, Johan
    et al.
    Västervik hospital.
    Mårdh, C
    Central Hospital, Kristianstad.
    Karlström, G
    Landstinget i Värmland.
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Characteristics and long-term outcome of acute exacerbations in chronic obstructive pulmonary disease: An analysis of cases in the Swedish Intensive Care Registry during 2002-20062008In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 52, no 6, p. 759-765Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) represents a major and growing health problem. The purpose of this work was to examine characteristics, resource use and long-term survival in patients with an acute exacerbation of COPD that were admitted to Swedish intensive care units (ICU). Methods: Patient characteristics at admission, length of stay (LOS), resource use and outcome were collected for admissions due to COPD during 2002-2006 in the database of the Swedish Intensive Care Registry. Vital status was secured for 99.6% of the patients. Kaplan-Meier survival estimates were computed for index admissions only. Results: We identified 1009 patients with 1199 admissions due to COPD (1.3% of all intensive care admissions). The mean (SD) age was 70.2 (9.1) years and the proportion of women were 61.5%. Mean (SD) Acute Physiology and Chronic Health Evaluation II probability of hospital death was 0.31 (0.19). Median LOS was 28 (interquartile range 52) h. The number of readmissions was 190 during the 5-year study. Older patients had fewer readmissions (OR 0.96, 95% CI: 0.95-0.98/year increase in age). ICU mortality was 7.3% (87 of 1199 admissions) and 30-day mortality was 26.0% (262 of 1009 index admissions). Median survival was 14.5 months and 31% of patients survived 3 years after the index admission. Conclusions: Short (30 days) and long-term survival is poor in acute COPD. Readmissions are frequent reflecting the severity of this chronic illness. Patients are less likely to be readmitted with increasing age which may be due to withholding of further intensive care. © 2008 The Authors.

  • 15.
    Berkius, Johan
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
    Sundh, J
    Örebro University Hospital, Sweden .
    Nilholm, L
    Örebro University Hospital, Sweden .
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    What determines immediate use of invasive ventilation in patients with COPD?2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 3, p. 312-319Article in journal (Refereed)
    Abstract [en]

    Background The choice between non-invasive ventilation (NIV) and invasive ventilation in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may be irrational. The aim of this study was to examine those patient characteristics, and circumstances deemed important in the choice made between NIV and invasive ventilation in the intensive care unit (ICU). Methods We first examined 95 admissions of AECOPD patients on nine ICUs and identified variables associated with invasive ventilation. Thereafter, a questionnaire was sent to ICU personnel to study the relative importance of different factors with a possible influence on the decision to use invasive ventilation at once. Results Univariable analysis showed that increasing age [odds ratio (OR) 1.06 per year] and increasing body mass index (BMI) (OR 1.11 per kg/m2) were associated with immediate invasive ventilation, while there was no such association with arterial blood gases or breath rate. BMI was the only factor that remained associated with immediate invasive ventilation in the multivariable analysis [OR 1.12 (95% confidence interval 1.031.23) kg/m2]. Ranking of responses to the questionnaire showed that consciousness, respiratory symptoms and blood gases were powerful factors determining invasive ventilation, whereas high BMI and age were ranked low. Non-patient-related factors were also deemed important (physician in charge, presence of guidelines, ICU workload). Conclusion Factors other than those deemed most important in guidelines appear to have an inappropriate influence on the choice between NIV and immediate intubation in AECOPD in the ICU. These factors must be identified to further increase the appropriate use of NIV.

  • 16.
    Berkius, Johan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences.
    Sundh, Josefin
    Orebro University Hospital.
    Nilholm, Lennart
    Orebro University Hospital.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Long-term survival according to ventilation mode in acute respiratory failure secondary to chronic obstructive pulmonary disease: A multicenter, inception cohort study2010In: JOURNAL OF CRITICAL CARE, ISSN 0883-9441, Vol. 25, no 3Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the study was to investigate 5-year survival stratified by mechanical ventilation modality in chronic obstructive pulmonary disease (COPD) patients treated in the ICU. Materials and Methods: Prospective, observational study of COPD patients with acute respiratory failure admitted to 9 multidisciplinary ICUs in Sweden. Characteristics on admission, including illness severity scores and the first blood gas, and survival were analyzed stratified by ventilation modality (noninvasive [NIV] vs invasive mechanical ventilation). Results: Ninety-three patients, mean age of 70.6 (SD, 9.6) years, were included. Sixteen patients were intubated immediately, whereas 77 were started on NIV. Patients who were started on NIV had a lower median body mass index (BMI) (21.9 vs 27.0; P andlt; .01) and were younger compared to those who were intubated immediately (median age, 70 vs 74.5 years; P andlt; .05). There were no differences in the initial blood gas results between the groups. Long-term survival was greater in patients with NIV (P andlt; .05, log rank). The effect of NIV on survival remained after including age, Acute Physiology and Chronic Health Evaluation II score, and BMI in a multivariate Cox regression model (NIV hazard ratio, 0.44; 95% confidence interval, 0.21-0.92). Fifteen patients with failed NIV were intubated and mechanically ventilated. Long-term survival in patients with failed NIV was not significantly different from patients who were intubated immediately. Conclusion: The short-term survival benefit of NIV previously found in randomized controlled trials still applies after 5 years of observation.

  • 17. Bäckman, C
    et al.
    Orwelius, Lotti
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Nordlund, P
    Simonsson, E
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Do ICU-diaries influence health related quality of life after critical illness?2007In: in Intensive Care Medicine(ISSN 0342-4642), vol 33, 2007, Vol. 33, p. 13-13Conference paper (Refereed)
  • 18.
    Bäckman, C
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology.
    Wahlter, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Kritiska tid på intensiven dokumenteras i dagbok.1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 468-470Article in journal (Other (popular science, discussion, etc.))
  • 19.
    Bäckman, Carl
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ahlberg, M
    Jones, C
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hollman Frisman, Gunilla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Gastroentorology.
    Group conversations after a long stay in the intensive care2014Conference paper (Other academic)
  • 20.
    Bäckman, Carl G
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Orwelius, Lotti
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Unit . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten M
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    A case-control study of the influence of the ICU-diary concept on mastery and hopelessness six months after critical illnessManuscript (preprint) (Other academic)
    Abstract [en]

    The ICU-diary concept is associated with less post-traumatic stress syndrome and improved perceived health-related quality-of-life (HRQoL) after critical illness, but little is known about its effect on the coping- mastery process, or whether it reduces hopelessness.

    Objective: To see if the ICU-diary concept improves the patient’s ability to master his/her situation after critical illness, and if it reduces the feeling of hopelessness.

    Design: Case control study (subgroup analysis of a multi-centre study on health-related quality-of-life (HRQoL).

    Setting: Non-academic 8-bed general ICU.

    Patients: Adults admitted between March 2002 and June 2004.

    Measurements: Mastery and hopelessness were determined using validated questionnaires (the Mastery-Coping scale and a consolidated 2–item hopelessness questionnaire) which were sent home to patients 6 months after critical illness. Responses were compared between patients that received (Cases: n=38) or did not receive an ICU-diary (Controls: n=76) . Diaries were used when a long and complicated stay on the ICU was expected. Controls were matched with diary patients by gender and age. The effect of the ICU-diary was also examined using a multiple regression model.

    Results: The ICU-diary concept group scored significantly higher than the No-diary group in mastery (22.1 vs. 20.4, P<0.05) and lower in hopelessness scores (1.3 vs. 1.6, P<0.05). The positive influence of the ICU-diary disappeared after adjustment for confounding factors in a multiple regression model.

    Conclusion: We were unable to verify any positive influence of the ICU-diary concept on mastery and hopelessness 6 months after critical illness.

  • 21.
    Bäckman, Carl G
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten M
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Use of a personal diary written on the ICU during critical illness2001In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, no 2, p. 426-9Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the use of a diary as an aid in debriefing patients and relatives following critical illness. Design: Observation study. Setting: Intensive care unit of a 500-bed hospital. Patients and participants: Fifty-one critically ill patients and their relatives. Method: A daily account of the patient's progress was written in everyday language by nursing staff, photographs were added as necessary. The booklet was given to the patient or a relative at a follow-up appointment 2 weeks after discharge from the unit. A standard questionnaire was mailed 6 months later, responses were analyzed by an independent observer. Measurements and results: All diaries had been read by survivors (n=41) or relatives (n=10), 51% of the diaries had been read more than 10 times. Comments in the questionnaires were graded as very positive (39%), positive (28%) and neutral (33%). Conclusions: A detailed narrative of the patient's stay is a useful tool in the debriefing process following intensive care.

  • 22.
    Bäckman, Carl
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Orwelius, Lotti
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Long-term effect of the ICU-diary concept on quality of life after critical illness2010In: ACTA ANAESTHESIOLOGICA SCANDINAVICA, ISSN 0001-5172, Vol. 54, no 6, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Background Critically ill patients often spend time in the intensive care unit (ICU) either unconscious or sedated. On recovery, they are often in a state of confusion with memory loss that may be associated with a longstanding reduction in health-related quality of life (QoL). We hypothesised that the ICU-diary concept could improve their QoL by filling in their memory gaps. Methods A non-randomised, prospective study in a non-academic eight-bedded general ICU. A group of patients (n=38) were selected to receive the ICU-diary concept (keeping a diary with photos while on the ICU plus a follow-up meeting) when a long and complicated course was expected. Health-related QoL at 6, 12, 24 and 36 months was compared with a group that did not receive the ICU-diary (n=224). The Medical Outcomes Study 36-Item Short-Form (SF-36) was used to measure health-related QoL. Multiple regression models adjusted for age, sex, illness severity, pre-existing disease and diagnostic category was used to analyse the effects of the ICU-diary concept at 6 months, and changes over time were analysed using repeated measures MANOVA. Results Crude and adjusted scores for two dimensions of SF-36 (general health and vitality) and the physical component summary score were significantly higher at 6 months in the ICU-diary group (P andlt; 0.05) and some of the effects remained during the 3-year follow-up period (P andlt; 0.05). Conclusion The ICU-diary concept was associated with improved health-related QoL during the 3-year follow-up period after a critical illness. The effect of this intervention needs to be confirmed in a larger randomised study.

  • 23.
    Bäckman, Carl
    et al.
    Norrköping.
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Use of personal diary written on the ICU during critical illness.2001In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 27, p. 426-429Article in journal (Refereed)
  • 24.
    De Geer, Lina
    et al.
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Oscarsson, Anna
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Cardiac mortality after septic shock.2015Conference paper (Refereed)
  • 25.
    De Geer, Lina
    et al.
    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.
    Oscarsson, Anna
    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 Norrköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Walther, Sten M.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Cardiac mortality after severe sepsis and septic shock: A nationwide observational cohort study2015Manuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences remain unclear. The aim of this study was to investigate cardiac outcome after sepsis by assessing causes of death in a nationwide register-based cohort.

    Methods: A cohort of 9,520 severe sepsis and septic shock intensive care (ICU) patients without preceding severe cardiac failure and discharged alive from the ICU was collected from the Swedish Intensive Care Registry (SIR) from 2008 to 2013, together with a nonseptic control group (n = 4,577). Patients were matched according to age, sex and severity of illness. Information on cause of death after ICU discharge was sought in the Swedish National Board of Health and Welfare’s Cause of Death Registry.

    Results: After ICU discharge, 3,954 (42%) of severe sepsis or septic shock patients died. In 654 (16%) of these, cardiac failure was registered as the cause of death. The follow-up time was 17,693 person-years (median 583 days/person; maximum 5.7 years) and the median (IQR) time from ICU discharge to cardiac failure-related death 81 (17 - 379) days. With increasing severity of illness (quartiles of SAPS3), the hazard rate for cardiac failure-related death increased (hazard ratio (HR) 1.58 (95% CI 1.19 - 2.09, p <0.001) in the highest quartile compared to the lowest). In a matched comparison between severe sepsis or septic shock patients and controls, survival was similar, and the hazard rate for cardiac failurerelated death did not differ between groups (HR 0.97, 95% CI 0.88 – 1.10, p = 0.62).

    Conclusions: The risk of death with cardiac failure as the cause of death after severe sepsis or septic shock increases with severity of illness on admission. Patients with severe sepsis or septic shock are not, however, at an increased risk of death with cardiac failure as the cause of death when compared to other ICU patients with similar severity of illness.

  • 26.
    de Geer, Lina
    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.
    Oscarsson Tibblin, Anna
    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.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Walther, Sten M.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    No association with cardiac death after sepsis: A nationwide observational cohort study2019In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 3, p. 344-351Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiac dysfunction is a well-known complication of sepsis, but its long-term consequences and implications for patients remain unclear. The aim of this study was to investigate cardiac outcome in sepsis by assessing causes of death up to 2 years after treatment in an Intensive Care Unit (ICU) in a nationwide register-based cohort collected from the Swedish Intensive Care Registry.

    METHODS: A cohort of 13 669 sepsis and septic shock ICU patients from 2008 to 2014 was collected together with a non-septic control group, matched regarding age, sex and severity of illness (n = 6582), and all without preceding severe cardiac disease. For a large proportion of the severe sepsis and septic shock patients (n = 7087), no matches were found. Information on causes of death up to 2 years after ICU admission was sought in the Swedish National Board of Health and Welfare's Cause of Death Registry.

    RESULTS: Intensive Care Unit mortality was nearly identical in a matched comparison of sepsis patients to controls (24% in both groups) but higher in more severely ill sepsis patients for whom no matches were found (33% vs 24%, P < 0.001). There was no association of sepsis to cardiac deaths in the first month (OR 1.03, 95%CI 0.87 to 1.20, P = 0.76) nor up to 2 years after ICU admission (OR 1.01, 95%CI 0.82 to 1.25, P = 0.94) in an adjusted between-group comparison.

    CONCLUSIONS: There was no association with an increased risk of death related to cardiac disease in patients with severe sepsis or septic shock when compared to other ICU patients with similar severity of illness.

  • 27.
    Dellerantz, E
    et al.
    Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Martner, J
    University of Gothenburg.
    Nolin, T
    Central Hospital Kristianstad.
    Wickerts, C-J
    Danderyds Sjukhus.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    LONG-TERM OUTCOME AFTER CARDIAC ARREST TREATED WITH THERAPEUTIC HYPOTHERMIA: RESULTS FROM THE SWEDISH INTENSIVE CARE REGISTRY2009In: in INTENSIVE CARE MEDICINE, vol 35, 2009, Vol. 35, p. 180-180Conference paper (Refereed)
    Abstract [en]

    n/a

  • 28.
    Engerström, Lars
    et al.
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svensson, Robert
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Riskjusterad mortalitet i intensivvården: Egen analys behövs för att dra rätt slutsatser från nationella register2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 23, p. 1160-1163Article in journal (Other academic)
    Abstract [en]

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

  • 29. Eriksson, H
    et al.
    Bernard, S
    Glenny, R
    Fedde, R
    polissar, N
    Basaraba, R
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Gaughan, E
    McMurphy, R
    Hlastala, M
    Effect of furosemide on pulmonary blood flow distribution in resting and wxercising horses.1999In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 86, p. 2034-2043Article in journal (Refereed)
  • 30.
    Erlandsson, Marcus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Burman, Lars G.
    Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
    Cars, Otto
    Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Lennart E.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    ICU-STRAMA Study Group,
    Prescription of antibiotic agents in Swedish intensive care units is empiric and adequate2007In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 39, no 1, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Since the prescription of antibiotics in the hospital setting is often empiric, particularly in the critically ill, and therefore fraught with potential error, we analysed the use of antibiotic agents in Swedish intensive care units (ICUs). We examined indications for antibiotic treatment, agents and dosage prescribed among 393 patients admitted to 23 ICUs at 7 tertiary care centres, 11 secondary hospitals and 5 primary hospitals over a 2-week period in November 2000. Antibiotic consumption was higher among ICU patients in tertiary care centres with a median of 84% (range 58-87%) of patients on antibiotics compared to patients in secondary hospitals (67%, range 35-93%) and in primary hospitals (38%, range 24-80%). Altogether 68% of the patients received antibiotics during the ICU stay compared to 65% on admission. Cefuroxime was the most commonly prescribed antibiotic before and during admission (28% and 24% of prescriptions, respectively). A date for decision to continue or discontinue antibiotic therapy was set in 21% (6/29) of patients receiving prophylaxis, in 8% (16/205) receiving empirical treatment and in 3% (3/88) when culture-based therapy was given. No correlation between antibiotic prescription and laboratory parameters such as CRP levels, leukocyte and thrombocyte counts, was found. The treatment was empirical in 64% and prophylactic in 9% of cases. Microbiological data guided prescription more often in severe sepsis (median 50%, range 40-60% of prescriptions) than in other specified forms of infection (median 32%, range 21-50%). The empirically chosen antibiotic was found to be active in vitro against the pathogens found in 55 of 58 patients (95%) with a positive blood culture. This study showed that a high proportion of ICU patients receive antimicrobial agents and, as expected, empirical-based therapy is more common than culture-based therapy. Antibiotics given were usually active in vitro against the pathogen found in blood cultures. We ascribe this to a relatively modest antibiotic resistance problem in Swedish hospitals.

  • 31.
    Erlandsson, Marcus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Department of Anaesthesiology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
    Giske, Christian G.
    Division of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Jonas, Daniel
    Institute of Environmental Medicine and Hospital Epidemiology, University Medical Centre, Freiburg, Germany.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nordlinder, David
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Antibiotic susceptibility patterns and clones of Pseudomonas aeruginosa in Swedish ICUs2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 6-7, p. 487-494Article in journal (Refereed)
    Abstract [en]

    Pseudomonas aeruginosa is 1 of the bacteria most adaptive to anti-bacterial treatment. Previous studies have shown nosocomial spread and transmission of clonal strains of P. aeruginosa in European hospitals. In this study we investigated antibiotic susceptibility and clonality in 101 P. aeruginosa isolates from 88 patients admitted to 8 Swedish ICUs during 2002. We also compared phenotypes and genotypes of P. aeruginosa and carried out cluster analysis to determine if phenotypic data can be used for surveillance of clonal spread. All isolates were collected on clinical indication as part of the NPRS II study in Sweden and were subjected to AFLP analysis for genotyping. 68 isolates with unique genotypes were found. Phenotyping was performed using MIC values for 5 anti-pseudomonal agents. Almost 6% of the isolates were multi-drug resistant (MDR), and this figure rose to almost 8% when intermediate isolates were also included. We found probable clonal spread in 9 cases, but none of them was found to be an MDR strain. Phenotypical cluster analysis produced 40 clusters. Comparing partitions did not demonstrate any significant concordance between the typing methods. The conclusion of our study is that cross-transmission and clonal spread of MDR P. aeruginosa does not present a clinical problem in Swedish ICUs, but probable cross-transmission of non-MDR clones indicate a need for improved hygiene routines bedside. The phenotype clusters were not concordant with genotype clusters, and genotyping is still recommended for epidemiological tracking.

  • 32.
    Erlandsson, Marcus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Hoffmann, Mikael
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Lindgren, Sune
    Sörén, L.
    Department of Clinical Microbiology, County Hospital, Jönköping .
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences.
    Surveillance of Antibiotic Resistance in ICUs in Southeastern Sweden1999In: Acta Anaesthesiol Scand, Vol. 43, no 8, p. 815-820Article in journal (Refereed)
    Abstract [en]

    Background: A study was designed to assess a computer-based program for continuous registration of antibiotic resistance, statistics concerning severity of illness, and consumption of antibacterial drugs.

    Methods: The frequency of antibiotic resistance among bacteria in eight ICUs in southeastern Sweden was investigated yearly from 1995 through 1997. The antibiotic consumption in the ICUs was registered as defined daily doses (DDD) and compared to severity of illness (APACHE-II scores).

    Results: There was a statistically significant increase in ampicillin resistance among Enterococcus spp. between 1996 and 1997, which was due to a shift from Enterococcus faecalis to Enterococcus faecium. A high prevalence of resistance among coagulase-negative staphylococci to oxacillin (≈ 70%), ciprofloxacin (≈ 50%), fucidic acid (≈ 50%) and netilmicin (≈ 30%) was seen in all ICUs during the whole study period. There was a statistically significant increase in ciprofloxacin resistance among Escherichia coli and Enterococcus spp. The resistance among Enterobacter spp. to cefotaxime decreased but this change was not statistically significant. Efforts were made to avoid betalactam antibiotics, except carbapenems, for treatment of infections caused by Enterobacter spp. and the consumption of cephalosporins decreased whereas the consumption of carbapenems increased. The total antibiotic consumption decreased by 2.5% during the study period. There was no correlation between APACHE II scores and antibiotic consumption.

    Conclusions: Each ICU within a hospital ought to have a program for "on-line" antibiotic resistance surveillance of drugs used in that unit so that changes in empirical treatment can be made when there is an increase in antibiotic-resistant isolates within that unit.

  • 33.
    Flaatten, H
    et al.
    Haukeland Hospital.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Martner, J
    Sahlgrens University Hospital.
    Nolin, T
    Kristianstad Hospital.
    Strand, K
    Stavanger University Hospital.
    Mussalo, P
    Intensium Ltd.
    Reinikainen, M
    Kuopio University Hospital.
    Ala-Kokka, T
    Oulu University Hospital.
    LENGTH OF STAY IN NORDIC ICUS2009In: in INTENSIVE CARE MEDICINE, vol 35, 2009, Vol. 35, p. 175-175Conference paper (Refereed)
    Abstract [en]

    n/a

  • 34.
    Fransson, G
    et al.
    Department of Geriatrics and Rehab, County Hospital, Kalmar, Sweden.
    Berkius, J
    Department of Anaesthesia and Intensive Care, Västervik Hospital, Sweden.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Kahlmeter, G
    Department of Clinical Microbiology, Central Hospital, Växjö, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Walther, Sten
    Surgical ICU, Ullevål University Hospital, Oslo, Norway.
    Linking local microbiology databases with the Swedish Intensive Care Registry to examine impact of bacterial resistance on the critically ill.2007In: Acta anaesthesiologica Scandinavica. Volume 51, Issue Supplement s118, Malden, MA, United States: Wiley-Blackwell, 2007, Vol. 51, p. 33-33 (Poster 25)Conference paper (Other academic)
    Abstract [en]

    Background and aims: Bacterial resistance to antibiotics hasemerged as an important factor influencing patient mortalityand morbidity. The overall purpose of this project is to exam-ine the impact of bacterial resistance on resource use andoutcome in the critically ill. The aims of the current report isto demonstrate that linkage of local microbiology databasesand the Swedish Intensive Care Registry (SIR) was possibleand to provide a preliminary analysis of data from a sub-group of ICU patients (chronic obstructive pulmonary dis-ease, COPD).

    Methods: Admissions due to an acute exacerbation of COPDwere matched with bacteriology samples obtained 14 daysbefore ICU admission, during ICU stay and 14 days after dis-charge from ICU by linking six local microbiology databaseswith patient data in SIR. Linkage was by the patient’s uniquepersonal number and ICU admission and discharge days.

    Results: We found 195 patients with median APACHE II prob-ability 0.22 (iqr 0.12–0.37), median length of stay (LOS) 46 (iqr 21–125) hours and 79% 30 day survival. Cultures from 2 weeks before (n=128), during ICU-stay (n=750) and from14 days after ICU discharge (n=228) were identified. During ICU stay airways (n=261), blood or intravascular devices (n=246) and other sites (n=243) were cultured. The totalnumber of airway cultures per patient increased linearly withlength of stay (P<0.01,r2= 0.61). Gram-negative bacteria were most common in positive airway cultures (41%) followedby Candida spp (22%), while positive blood cultures were pre-dominantly Gram-positive (71%). 30-day-mortality was 10/53 with positive and 10/29 with negative airway cultures(P=0.23).

    Conclusion: Linkage of local microbiology databases and theSwedish Intensive Care Registry is possible and can generate information that may be used to examine relationships between bacterial resistance and outcomes in the critically illpatient.

  • 35. Fransson, G
    et al.
    Edström, M
    Nilsson, L E
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    High mortaility in bacteraemia and candidaemia in critically ill patients - report from Swedish Intensive Care Registry2012In: Proceedings of the 22nd European Congress of Clinical Microbiology and Infectious Diseases, 2012, p. P1060-Conference paper (Other academic)
    Abstract [en]

    Objective: Increasing prevalence of  bacteremia and candidemia with significant resistance to antimicrobial agents is an increasing concern among ICU patients. The objective of this report from Swedish Registry of Intensive care (SIR) was to study the frequency and cause of culture verified sepsis in critically ill patients and to analyse mortality in sepsis caused by Candida albicans, Candida non albicans and bacteria.

    Methods: Setting: Starting 10 years ago an increasing number of ICU:s in Sweden reports each episode of care (EOC) to the Swedish Intensive care Registry (SIR).  Mortality is followed weekly for all patients by link to the Swedish population registry. A specific routine for collection of microbial data directly from the laboratories connected individually to each EOC has been tested and implemented for laboratories covering 1/3 of the Swedish population. Participants: 47 ICU:s reported 1540 EOC:s during the period January 2005 to November 2011, with a diagnosis of sepsis (ICD10: A419, R572 or R651) and a positive blood culture within 14 days before admission until discharge.  For patients with more than one EOC was only the last EOC included which reduced the number of observations included in mortality calculations to 1416.

    Variables: Primary outcome was 30 day mortality calculated from admission to ICU.

    Results: 1 416 patients met inclusion criteria and were included in the analysis. The most common causes of sepsis were:  E. coli (24 %) followed by Coagulase Negative Staphylococci (CoNS) (21 %), Streptococcus spp (19 %), S. aureus (14 %), Klebsiella spp (8 %) and Candida spp (6 %) [Candida albicans 4 % and Candida non albicans 2 %]. The 30-days crude mortality was 34% for patients with sepsis caused by S. aureus. Correspondingly 30 days mortality was for  Candida non albicans 34%, Candida albicans 31%,  Klebsiella spp 26 % , CoNS 25 %, E. coli 22 %. Distribution of species in blood cultures from the 87 patients with candidemia were: C. albicans 62, C. glabrata 11, C. krusei 1, C. tropicalis 4, C. other 4, C. non specified 9.

    Conclusion: The highest (>30%) crude mortality in critically ill patients with sepsis was seen in patients with S. aureus and Candida infections. Further analysis of independent risk factors for mortality in sepsis caused by different pathogens are warranted.

  • 36. Freter, W
    et al.
    Engerström, L
    Sellgren, J
    Öwall, A
    Jawad, J
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Rekalibrering av Higgins' ICU admission score baserad på data från svensk thoraxintensivvård2012In: Thoraxmötet Göteborg, 2012Conference paper (Refereed)
  • 37.
    Genaridis, Apostolos
    et al.
    Södersjukhuset, Stockholm, Sweden.
    Engerström, L
    Berkius, Johan
    Västerviks sjukhus, Västervik, Sweden.
    Wickerts, Carl-Johan
    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 and Medicine Center, Department of Thoracic and Vascular Surgery.
    Can we predict who will benefit from non-invasive ventilation in hypoxemic acute respiratory failure?2015Conference paper (Other academic)
  • 38. Gunnarsson, Mats
    et al.
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Seidal, Tomas
    Lennquist, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Effects of inhalation of corticosteroids immediately after experimental chlorine gas lung injury2000In: Journal of Trauma - Injury, Infection and Critical Care, ISSN 1079-6061, Vol. 48, no 1, p. 101-107Article in journal (Refereed)
    Abstract [en]

    Background: To assess the effects of treatment with nebulized corticosteroids immediately after chlorine gas injury. Methods: Eighteen anesthetized and mechanically ventilated pigs were exposed to chlorine gas (140 ppm for 10 minutes) and observed for 6 hours. Nine pigs were treated with nebulized beclomethasone-dipropionate 20 ╡g/kg (BDP group), and nine pigs were given no treatment (control group). Results: All animals developed severe pulmonary dysfunction. The initial decrease in PaO2 was similar in both groups, but BDP-treated animals improved whereas control animals deteriorated (p < 0.005, analysis of variance). Pulmonary vascular resistance increased in both groups but less in the BDP group (p < 0.01). Lung-thorax compliance was better preserved in the BDP group (p < 0.01), and oxygen delivery was significantly better in the BDP group (p < 0.01). One animal died in the BDP group, as did three animals in the control group. Conclusion: Immediate treatment with nebulized BDP improved pulmonary and cardiovascular function after experimental chlorine gas injury.

  • 39.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Antonelli, Massimo
    Policlinico University of A. Gemelli, Rome, Italy.
    Holmbom, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Lipman, Jeffrey
    University of Queensland, Herston, Australia.
    Pickkers, Peter
    Radboud University Medical Centre, Nijmegen, The Netherlands.
    Leone, Marc
    Aix Marseille University, France.
    Rello, Jordi
    University Autonoma of Barcelona, Spain.
    Sakr, Yasser
    Friedrich-Schiller University, Jena, Germany.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanhems, Philippe
    University of Lyon 1, France.
    Vincent, Jean-Louis
    University Libre Bruxelles, Belgium.
    Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels2014In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 14, no 513Article in journal (Refereed)
    Abstract [en]

    Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance. Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of greater than= 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of less than 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden). Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P less than 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P less than 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P less than 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections. Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.

  • 40.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Arman, Dilek
    Gazi University School of Medicine.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Jindrák, Vlastimil
    Na Homolce Hospital, Praha, Czech Republic.
    Kalenic, Smilja
    Clinical Hospital Centre, Zagreb, Croatia.
    Kurcz, Andrea
    National Centre for Epidemiologia, Budapest, Hungary.
    Licker, Monica
    “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania.
    Naaber, Paul
    United Laboratories, Tartu University Clinics.
    Scicluna, Elizabeth A.
    Mater Dei Hospital, Malta .
    Vanis, Václav
    Na Homolce Hospital, Praha, Czech Republic.
    Walther, Sten M.
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control2009In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, no 1, p. 91-100Article in journal (Refereed)
    Abstract [en]

    Purpose: To report initial results from a European ICU surveillance programme focussing on antibiotic consumption, microbial resistance and infection control.

    Methods: Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and infection control stewardship measures were entered locally into a web-application. Results were validated locally, aggregated by project leaders and fed back to support local audit and benchmarking.

    Results: Median (range) antibiotic consumption was 1,254 (range 348–4,992) DDD per 1,000 occupied bed days. The proportion of MRSA was median 11.6% (range 0–100), for ESBL phenotype of E. coli and K. pneumoniae 3.9% (0–80) and 14.3% (0–77.8) respectively, and for carbapenem-resistant P. aeruginosa 22.5% (0–100). Screening on admission for alert pathogens was commonly omitted, and there was a lack of single rooms for isolation.

    Conclusions: The surveillance programme demonstrated wide variation in antibiotic consumption, microbial resistance and infection control measures. The programme may, by providing rapid access to aggregated results, promote local and regional audit and benchmarking of antibiotic use and infection control practices.

  • 41.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Burman, LG
    Cars, O
    Erlandsson, Marcus
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nordlinder, D
    Walther, Sten
    Linköping University, Department of Medicine and Care, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Low antibiotic resistance rates in Staphylococcus aureus, Escherichia coli and Klebsiella spp but not in Enterobacter spp and Pseudomonas aeruginosa: A prospective observational study in 14 Swedish ICUs over a 5-year period2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 7, p. 937-941Article in journal (Refereed)
    Abstract [en]

    Background: Intensive care units (ICUs) are hot zones for emergence and spread of antibiotic resistance because of frequent invasive procedures, antibiotic usage and transmission of bacteria. We report prospective data on antibiotic use and bacterial resistance from 14 academic and non-academic ICUs, participating in the ICU-STRAMA programme 1999-2003. Methods: The quantity of antibiotics delivered to each ICU was calculated as defined daily doses per 1000 occupied bed days (DDD1000). Specimens for culture were taken on clinical indications and only initial isolates were considered. Species-related breakpoints according to the Swedish Reference Group for Antibiotics were used. Antibiotic resistance was defined as the sum of intermediate and resistant strains. Results: Mean antibiotic use increased from 1245 DDD1000 in 1999 to 1510 DDD1000 in 2003 (P = 0.11 for trend). Of Staphylococcus aureus, 0-1.8% were methicillin resistant (MRSA). A presumptive extended spectrum beta-lactamase (ESBL) phenotype was found in <2.4% of Escherichia coli, based on cefotaxime susceptibility, except a peak in 2002 (4.6%). Cefotaxime resistance was found in 2.6-4.9% of Klebsiella spp. Rates of resistance among Enterobacter spp. to cefotaxime (20-33%) and among Pseudomonas aeruginosa to imipenem (22-33%) and ciprofloxacin (5-21%) showed no time trend. Conclusion: MRSA and cefotaxime-resistant E. coli and Klebsiella spp strains were few despite high total antibiotic consumption. This may be the result of a slow introduction of resistant strains into the ICUs, and good infection control. The cause of imipenem and ciprofloxacin resistance in P. aeruginosa could reflect the increased consumption of these agents plus spread of resistant clones. © 2007 The Authors.

  • 42.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Erlandsson, Marcus
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Burman, Lars G.
    Swedish Institute for Infectious Diseases Control, Solna, Sweden.
    Cars, Otto
    Swedish Institute for Infectious Diseases Control, Solna, Sweden.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Lindgren, Sune
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Olsson-Liljequist, Barbro
    Swedish Institute for Infectious Diseases Control, Solna, Sweden.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    High Antibiotic Susceptibility Among Bacterial Pathogens In Swedish ICUs2004In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 1, p. 24-30Article in journal (Refereed)
    Abstract [en]

    Local infection control measures, antibiotic consumption and patient demographics from 1999-2000 together with bacteriological analyses were investigated in 29 ICUs participating in the ICU-STRAMA programme. The median antibiotic consumption per ICU was 1147 (range 605-2143) daily doses per 1000 occupied bed d (DDD1000). Antibiotics to which >90% of isolates of an organism were susceptible were defined as treatment alternatives (TA90). The mean number of TA90 was low (1-2 per organism) for Enterococcus faecium (vancomycin:VAN), coagulase negative staphylococci (VAN), Pseudomonas aeruginosa (ceftazidime:CTZ, netilmicin: NET) and Stenotrophomonas maltophilia (CTZ, trimethoprim-sulfamethoxazole: TSU), but higher (3-7) for Acinetobacter spp. (imipenem:IMI, NET, TSU), Enterococcus faecalis (ampicillin:AMP, IMI, VAN), Serratia spp. (ciprofloxacin:CIP, IMI, NET), Enterobacter spp. (CIP, IMI, NET, TSU), E. coli (cefuroxime:CXM, cefotaxime/ceftazidime:CTX/CTZ, CIP, IMI, NET, piperacillin-tazobactam:PTZ, TSU), Klebsiella spp. (CTX/CTZ CIP, IMI, NET, PTZ, TSU) and Staphylococcus aureus (clindamycin, fusidic acid, NET, oxacillin, rifampicin, VAN). Of S. aureus isolates 2% were MRSA. Facilities for alcohol hand disinfection at each bed were available in 96% of the ICUs. The numbers of TA90 available were apparently higher than in ICUs in southern Europe and the US, despite a relatively high antibiotic consumption. This may be due to a moderate ecological impact of the used agents and the infection control routines in Swedish ICUs.

  • 43.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Leone, Marc
    Department of Anesthesiology and Intensive Care Medicine, Nord Hospital, Marseille, France.
    Barie, Philip S
    Department of Surgery, Weill Cornell Medical College, New York, USA.
    Rello, Jordi
    Critical Care Department, Vall d’Hebron University Hospital, CIBERES, VHIR, Universitat Autónoma de Barcelona, Spain.
    Lipman, Jeffrey
    Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and Burns Trauma Critical Care Research Centre, University of Queensland, Queensland, Australia.
    Marshall, John C
    Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
    Anzueto, Antonio
    Department of Pulmonary/Critical Care, University of Texas Health Science Center, San Antonio, TX, USA.
    Sakr, Yasser
    Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany.
    Pickkers, Peter
    Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
    Felleiter, Peter
    Intensive Care Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland.
    Engoren, Milo
    Department of Anesthesiology, Mercy St Vincent Medical Center, Toledo, OH, USA.
    Vincent, Jean-Louis
    Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
    Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: results from the EPIC II study2011In: International Journal of Antimicrobial Agents, ISSN 0924-8579, E-ISSN 1872-7913, Vol. 38, no 4, p. 331-335Article in journal (Refereed)
    Abstract [en]

    Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P andlt; 0.01) and corresponding hospital mortality rates were 36.4% and 27.0% (P andlt; 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P = 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.

  • 44.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, M.
    Örebro University Hospital, Sweden .
    Vánky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, O.
    Örebro University Hospital, Sweden .
    Håkanson, E.
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery2014In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

    METHODS:

    A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

    RESULTS:

    Preoperative NT-proBNP≥1028 ng litre(-1) [odds ratio (OR) 9.9, 95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP≥1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

    CONCLUSIONS:

    Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

  • 45.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Mårten
    Departments of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Friberg, Örjan
    Departments of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital.
    Håkanson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    EuroSCORE II and NT-proBNP for risk evaluation: an observational longitudinal study in patients undergoing CABGManuscript (preprint) (Other academic)
    Abstract [en]

    BACKGROUND: Postoperative heart failure remains the major cause of death after cardiac surgery. As NT-proBNP is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

    METHODS: 365 patients with acute coronary syndrome (ACS) undergoing isolated CABG were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure postoperatively according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on Reciever Operating Chracateristics (ROC) analysis these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng/L. Follow-up time averaged 4.4 ± 0.7 years.

    RESULTS: Preoperative NT-proBNP ≥ 1028 ng/L (OR 9.9, 95%CI 1.01-98.9;p=0.049) and EuroSCORE II (OR 1.24, 95%CI 1.06-1.46;p=0.008) independently predicted severe circulatory failure postoperatively. In intermediate risk patients (EuroSCORE II 2.0 – 10.0) NT-proBNP ≥ 1028 ng/L was associated with a higher incidence of severe circulatory failure (6.6% vs 0%;p=0.007), renal failure (14.8% vs 5.4%;p=0.03), stroke (6.6 % vs 0.7 %;p=0.03) , longer ICU stay (37±35 vs 27±38 hours; p=0.002) and worse long-term survival.

    CONCLUSIONS: Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NTproBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

  • 46.
    Holm, Jonas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vidlund, Mårten
    Örebro University, Sweden.
    Vanky, Farkas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Friberg, Örjan
    Örebro University Hospital, Sweden.
    Håkansson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    NT-proBNP provides additional prognostic information to Euroscoe II in patients undergoing CABG2013Conference paper (Other academic)
  • 47. Holmberg, M
    et al.
    Steins, K
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Does high ICU occupancy have adverse effects on patient outcomes? An observational multicentre study of the relationship between occupancy, length-of-stay and mortality2013Conference paper (Refereed)
  • 48.
    Holmberg, M
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Acute Health Care in Norrköping.
    Steins, Krisjanis
    Linköping University, Department of Science and Technology, Communications and Transport Systems. Linköping University, The Institute of Technology.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Does high ICU occupancy have adverse effects on patient outcomes? An obeservational multicentre study of the relationship between occupancy, length-of-stay and mortality2013In: Intensive Care Medicine, 2013Conference paper (Refereed)
  • 49.
    Hällgren, Anita
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology.
    Burman, L
    Olsson-Liljequist, B
    Isaksson, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Saedi, B
    Walther, Sten
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hanberger, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Hög frekvens an korskolonisering med resistenta enterokocker hos "långliggare" på IVA2004In: Hygiea,2004, 2004, p. 57-57Conference paper (Other academic)
  • 50.
    Hällgren, Anita
    et al.
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Burman, Lars G
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Isaksson, Barbro
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Olsson-Liljeqvist, Barbro
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Saeedi, Baharak
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Rectal colonization and frequency of enterococcal cross-transmission among prolonged-stay patients in two Swedish intensive care units2005In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 37, no 8, p. 561-571Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to gain insight into the dynamics of the rectal flora during prolonged ICU stay, with a particular focus on colonization and cross-transmission with resistant pathogens, and to evaluate methods for the rapid isolation of relevant bacteria from rectal swabs. Patients admitted to a general intensive care unit (GICU) or a cardiothoracic ICU (TICU) at the University Hospital of Linköping, Sweden, between 1 November 2001 and January 2002 with a length of stay > 5 d were included (n = 20). Chromogenic UTI agar medium was used for discrimination of different species, and appropriate antibiotics were added to detect resistance. Direct plating was compared to enrichment broth for a subset of specimens. The study showed an early alteration in rectal flora, with a dramatic decrease in Gram-negative rods in favour of Gram-positive bacteria. An ampicillin- and high-level gentamicin resistant clone of Enterococcus faecium was found in 6 of 10 patients in the GICU and 2 of 11 patients in the TICU. Enrichment broth did not enhance the detection of Gram-negative bacteria compared to direct plating on Chromogenic UTI medium, but enrichment broths were needed for optimal detection of resistant Gram-positive bacteria.

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