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

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

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

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

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

  • 2.
    Chew, Michelle
    Operations- och intensivvårdskliniken, Hallands sjukhus, Halmstad.
    Snabb behandling vid septisk chock räddar liv: Även om "early goal-directed therapy"-protokoll inte ger effekt i nya studier2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 112, p. 1-2, article id DFUCArticle in journal (Other academic)
  • 3.
    Chew, Michelle S
    et al.
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Mangelus, Claes
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful – but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Refereed)
  • 4.
    Chew, Michelle S
    et al.
    Department of Anaesthesia and Intensive Care, Hallands sjukhus Halmstad.
    Mangelus, Claes
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Enlund, Gunnar
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Spetz, Peter
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Lyckner, Sara
    From the Swedish Perioperative Register, Uppsala Clinical Research Centre, Uppsala, Sweden.
    Surgery was successful--but how did it go for the patient? Experiences from and hopes for the Swedish Perioperative Register.2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 7, p. 453-454Article in journal (Other academic)
  • 5.
    Chew, Michelle S
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Walder, Bernhard
    University Hospital Geneva, Switzerland.
    Improving perioperative outcome: time to update protocols2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 4, p. 185-188Article in journal (Other academic)
    Abstract [en]

    n/a

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

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

  • 7.
    Dhanani, Jayesh A
    et al.
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Parker, Suzanne L
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia.
    Lipman, Jeffrey
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia.
    Wallis, Steven C
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia.
    Cohen, Jeremy
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Fraser, John
    Critical Care Research Group, The University of Queensland, Brisbane, Australia.
    Barnett, Adrian
    Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, Australia.
    Chew, Michelle S
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Roberts, Jason A
    Burns, Trauma and Critical Care Research Centre, The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, QLD 4029, Australia; Department of Intensive Care Medicine, Royal Brisbane and Womens Hospital, Brisbane, Australia; School of Pharmacy, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Royal Brisbane and Womens Hospital, Brisbane, Australia.
    Recovery rates of combination antibiotic therapy using in vitro microdialysis simulating in vivo conditions2018In: Journal of pharmaceutical analysis, ISSN 2214-0883, Vol. 8, no 6, p. 407-412Article in journal (Refereed)
    Abstract [en]

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

  • 8.
    Jammer, Ib
    et al.
    Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Anaesthesia and Intensive Care, Haukeland University Hospital,.
    Wickboldt, Nadine
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Sander, Michael
    Department of Anaesthesia and Intensive Care, Charite, Berlin, Germany.
    Smith, Andrew
    Royal Lancaster Infirmary, Lancaster University, Lancaster, UK.
    Schultz, Marcus J
    Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
    Pelosi, Paolo
    Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital,University of Genoa, Genoa, Italy.
    Leva, Brigitte
    European Society of Anaesthesiology, Brussels, Belgium.
    Rhodes, Andrew
    Critical Care, St George’s Hospital, London, UK.
    Hoeft, Andreas
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany .
    Walder, Bernhard
    Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Geneva, Geneva, Switzerland.
    Chew, Michelle S
    Department of Anaesthesia and Intensive Care Medicine, Hallands Sjukhus, Halmstad, Sweden Institute of Clinical Sciences, Lund University, Sweden.
    Pearse, Rupert M
    Queen Mary University of London, London, UK.
    Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions2015In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 32, no 2, p. 88-105Article in journal (Refereed)
    Abstract [en]

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

  • 9.
    Jawad, Monir
    et al.
    Department of Anaesthesiology and Intensive Care, Central Hospital in Kristianstad, Kristianstad, Sweden.
    Baigi, Amir
    Department of Primary Healthcare, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Oldner, Anders
    Department of Anaesthesiology, Karolinska University Hospital and Institute, Surgical Services and Intensive Care, Stockholm, Sweden.
    Pearse, Rupert M
    Queen Mary University of London and Adult Critical Care Unit, Royal London Hospital, London, UK.
    Rhodes, Andrew
    Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London, UK.
    Seeman-Lodding, Helen
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Chew, Michelle S
    Institute of Clinical Sciences Malmö, Lund University, Lund and the Department of Anaesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden.
    Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery.2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 5, p. 317-325Article in journal (Refereed)
    Abstract [en]

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

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

    DESIGN: An observational cohort study.

    SETTING: Six universities and two regional hospitals in Sweden.

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

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

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

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

  • 10.
    Kollind, M.
    et al.
    Centalsjukhuset Kristianstad, Sweden.
    Wickbom, F.
    Hallands Sjukhus, Sweden.
    Wilkman, E.
    University of Helsinki, Finland.
    Snackestrand, M. S. C.
    Sahlgrenska University Hospital, Sweden.
    Holmen, A.
    Regional Halland, Sweden.
    Oldner, A.
    Karolinska University Hospital, Sweden.
    Perner, A.
    Rigshosp, Denmark.
    Aneman, A.
    University of New South Wales, Australia.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Shock treatment in a cohort of Scandinavian intensive care units in 20142016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 7, p. 945-957Article in journal (Refereed)
    Abstract [en]

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

  • 11.
    Lundberg, Oscar H. M.
    et al.
    Skåne University Hospital Malmö, Sweden.
    Bergenzaun, Lill
    Skåne University Hospital Malmö, Sweden.
    Ryden, Jorgen
    Skåne University Hospital Malmö, Sweden.
    Rosenqvist, Mari
    Skåne University Hospital Malmö, Sweden.
    Melander, Olle
    Skåne University Hospital Malmö, Sweden; Lund University, Sweden.
    Chew, Michelle
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Lund University, Sweden.
    Adrenomedullin and endothelin-1 are associated with myocardial injury and death in septic shock patients2016In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 20, no 178Article in journal (Refereed)
    Abstract [en]

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

  • 12.
    Snygg, Johan
    et al.
    Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Anaesthesiol & Intens Care, Gothenburg, Sweden, Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden.
    Andersson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Fredrikson, Mats
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Chew, Michelle S
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping (ANOPIVA).
    Nordström, Rasmus (Contributor)
    Region Östergötland.
    Linhardt, Michael (Contributor)
    Region Östergötland.
    de Geer, Lina (Contributor)
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland.
    Myocardial injury in noncardiac surgery in Sweden: Study protocol for a multicentre, observational cohort study of patients undergoing elective, major abdominal surgery2019In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 5, p. 383-385Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 13.
    Toft, Palle
    et al.
    Department Anaesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK - 5000 Odense C, Denmark .
    Olsen, Hanne Tanghus
    Department Anaesthesiology and Intensive Care, Svendborg Hospital, Valdemarsgade 5 5700 Svendborg, Denmark, .
    Jørgensen, Helene Korvenius
    Department Anaesthesiology and Intensive Care, Hospital Lillebaelt, Skovvangen 2-8, 6000 Kolding, Denmark .
    Strøm, Thomas
    Department Anaesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK - 5000 Odense C, Denmark .
    Nibro, Helle Lykkeskov
    Department Anaesthesiology and Intensive Care, Aarhus University Hospital Nørrebrogade 44, 8000 Aarhus, Denmark .
    Oxlund, Jacob
    Department Anaesthesiology and Intensive Care, Esbjerg Hospital, Frihedsvej 15, 6700 Esbjerg, Denmark .
    Wian, Karl-Andre
    Department Anaesthesiology and Intensive Care, Vestfold Hospital, Halfdan Wilhelmsens alle 17, 3116 Tonsberg, Norway. .
    Ytrebø, Lars Marius
    Department Anaesthesiology and Intensive Care, University Hospital of North Norway .
    Kroken, Bjørn Anders
    Department Anaesthesiology and Intensive Care, University Hospital of North Norway .
    Chew, Michelle
    8Department Anaesthesiology and Intensive Care, Hallands Hospital, Lasarettsvägen, 302 33 Halmstad, Sweden. .
    Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation (NONSEDA Trial): study protocol for a randomised controlled trial2014In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 15, no 499, p. 1-11Article in journal (Refereed)
    Abstract [en]

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

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

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

    TRIAL REGISTER: ClinicalTrials.gov NCT0196768, 09.01.2014.

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