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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.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Bäckman, C
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Jones, C
    Musculoskeletal Biologu, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.
    Walther, S
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hollman Frisman, Gunilla
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Moving forward in life after being an on-looker in intensive care partner's experience of group-communication2016Conference paper (Refereed)
    Abstract [en]

    Background: Partners have a burdensome time during and after their partners’ intensive care period. They may appear to be coping well

    outwardly 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 intensive

    care patients.

    Design: The study has a descriptive intervention-based design where group communication for partners of former, surviving intensive care

    unit (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, aged

    37–89 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 of

    the 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 participate

    in group communication.

    Conclusion: Partners of an intensive care patient are on a journey, constantly trying to adapt to the new situation and find new strategies

    to ever-changing circumstances. Group communications contributed to togetherness and confirmation. To share experiences with others is one

    way 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 of

    being a partner to an intensive care patient. Group communications needs to be further developed and evaluated to obtain consensus and

    evidence for the best practice.

    Key words: Communication • Content analysis • Intensive care • Nursing • Partners

  • 4. 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)
  • 5.
    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.

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    fulltext
  • 6.
    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.

  • 7. 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]

      

  • 8.
    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)
  • 9.
    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)
  • 10.
    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)
  • 11. 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)
  • 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.
    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)
  • 13. 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]

      

  • 14.
    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.

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  • 15.
    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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    Bruno, Raphael Romano
    et al.
    Heinrich Heine Univ Duesseldorf, Germany.
    Wernly, Bernhard
    Paracelsus Med Univ, Austria; Karolinska Univ Hosp, Sweden.
    Kelm, Malte
    Heinrich Heine Univ Duesseldorf, Germany; Cardiovasc Res Inst Dusseldorf, Germany.
    Boumendil, Ariane
    St Hop Paris, France.
    Morandi, Alessandro
    Dept Rehabil Hosp Ancelle Cremona, Italy; Geriatr Res Grp, Italy.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Artigas, Antonio
    CIBERes Corporac Sanitaria Univ Parc Tau, Spain.
    Finazzi, Stefano
    Ist Ric Farmacol Mario Negri IRCCS, Italy.
    Cecconi, Maurizio
    Humanitas Univ, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Denmark.
    Faraldi, Loredana
    Grande Osped Metropolitano Niguarda, Italy.
    Lichtenauer, Michael
    Paracelsus Med Univ, Austria.
    Muessig, Johanna M.
    Heinrich Heine Univ Duesseldorf, Germany.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Moreno, Rui
    Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    1K12 Ghent Univ Hosp, Belgium.
    ohman, Christina Agvald
    Karolinska Univ Hosp, Sweden.
    Pinto, Bernardo Bollen
    Geneva Univ Hospitals, Switzerland.
    Soliman, Ivo W.
    Univ Utrecht, Netherlands.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Austria.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Leaver, Susannah
    Res Lead Critical Care Directorate St Georges Hos, England.
    Boulanger, Carole
    Royal Devon & Exeter NHS Fdn Trust, England.
    Walther, Sten
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    ICU, Ukraine.
    Elhadi, Muhammed
    Alkhums Hosp, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    De Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Guidet, Bertrand
    St Hop Paris, France; Sorbonne Univ, France; INSERM, France.
    Flaatten, Hans
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Jung, Christian
    Heinrich Heine Univ Duesseldorf, Germany.
    Management and outcomes in critically ill nonagenarian versus octogenarian patients2021In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 21, no 1, article id 576Article in journal (Refereed)
    Abstract [en]

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

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  • 19. 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)
  • 20.
    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.))
  • 21.
    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)
  • 22.
    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.

  • 23.
    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.

  • 24.
    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.

  • 25.
    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)
  • 26.
    Chew, Michelle
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Kattainen, Salla
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Haase, Nicolai
    Copenhagen Univ Hosp, Denmark.
    Buanes, Eirik A.
    Helse Bergen Hlth Trust, Norway.
    Kristinsdottir, Linda B.
    Landspitali Natl Univ Hosp Iceland, Iceland.
    Hofso, Kristin
    Oslo Univ Hosp, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Laake, Jon Henrik
    Oslo Univ Hosp, Norway; Oslo Univ Hosp, Norway.
    Kvale, Reidar
    Helse Bergen HF, Norway; Haukeland Hosp, Norway.
    Hastbacka, Johanna
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Reinikainen, Matti
    Univ Eastern Finland, Finland; Kuopio Univ Hosp, Finland.
    Bendel, Stepani
    Univ Eastern Finland, Finland; Kuopio Univ Hosp, Finland.
    Varpula, Tero
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland.
    Walther, Sten
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Health, Medicine and Caring Sciences. Varmland Cty Council, Sweden.
    Perner, Anders
    Copenhagen Univ Hosp, Denmark.
    Flaatten, Hans K.
    Helse Bergen HF, Norway; Haukeland Hosp, Norway.
    Sigurdsson, Martin I
    Landspitali Natl Univ Hosp Iceland, Iceland; Univ Iceland, Iceland.
    A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries2022In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 66, no 1, p. 56-64Article in journal (Refereed)
    Abstract [en]

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

  • 27.
    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)
  • 28.
    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.

  • 29.
    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 (ANOPIVA).
    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 (ANOPIVA).
    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, 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.

  • 30.
    de Lange, Dylan W.
    et al.
    Univ Utrecht, Netherlands.
    Soliman, Ivo W.
    Univ Utrecht, Netherlands.
    Leaver, Susannah
    St George Hosp, England.
    Boumendil, Ariane
    Hop St Antoine, France.
    Haas, Lenneke E. M.
    Diakonessen Hosp, Netherlands.
    Watson, Ximena
    St George Hosp, England.
    Boulanger, Carol
    Royal Devon & Exeter NHS Fdn Trust, England.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain; Sagrado Corazon Gen Cataluna Univ Hosp, Spain.
    Morandi, Alessandro
    Hosp Ancelle Cremona, Italy; Geriatr Res Grp, Italy.
    Andersen, Finn
    Alesund Hosp, Norway; NTNU, Norway.
    Jung, Christian
    Univ Hosp Dusseldorf, Germany.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal; Univ Beira Interior, Portugal.
    Walther, Sten M.
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Cecconi, Maurizio
    IRCCS, Italy; Humanitas Univ, Italy.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    ICU, Ukraine.
    Elhadi, Muhammed
    ICU, Alkhums Hosp, Libya.
    Fjolner, Jesper
    Viborg Reg Hosp, Denmark.
    Guidet, Bertrand
    Hop St Antoine, France.
    Flaatten, Hans
    Univ Bergen, Norway.
    The association of premorbid conditions with 6-month mortality in acutely admitted ICU patients over 80 years2024In: Annals of Intensive Care, E-ISSN 2110-5820, Vol. 14, no 1, article id 46Article in journal (Refereed)
    Abstract [en]

    Background Premorbid conditions influence the outcome of acutely ill adult patients aged 80 years and over who are admitted to the ICU. The aim of this study was to determine the influence of such premorbid conditions on 6 month survival. Methods Prospective cohort study in 242 ICUs from 22 countries including patients 80 years or above, admitted over a 6 months period to an ICU between May 2018 and May 2019. Only emergency (acute) ICU admissions in adult patients &gt;= 80 years of age were eligible. Patients who were admitted after planned/elective surgery were excluded. We measured the Clinical Frailty Scale (CFS), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), disability with the Katz activities of daily living (ADL) score, comorbidities and a Polypharmacy Score (CPS). Results Overall, the VIP2 study included 3920 patients. During ICU stay 1191 patients died (30.9%), and another 436 patients (11.1%) died after ICU discharge but within the first 30 days of admission, and an additional 895 patients died hereafter but within the first 6 months after admission (22.8%). The 6 months mortality was 64%. The median CFS was 4 (IQR 3-6). Frailty (CFS &gt;= 5) was present in 26.6%. Cognitive decline (IQCODE above 3.5) was found in 30.2%. The median IQCODE was 3.19. A Katz ADL of 4 or less was present in 27.7%. Patients who surviving &gt; 6 months were slightly younger (median age survivors 84 with IQR 81-86) than patients dying within the first 6 months (median age 84, IQR 82-87, p = 0.013), were less frequently frail (CFS &gt; 5 in 19% versus 34%, p &lt; 0.01) and were less dependent based on their Katz activities of daily living measurement (median Katz score 6, IQR 5-6 versus 6 points, IQR 3-6, p &lt; 0.01). Conclusions We found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making. ClinicalTrials.gov: NCT03370692. Conclusions We found that Clinical Frailty Scale, age, and SOFA at admission were independent prognostic factors for 6 month mortality after ICU admission in patients age 80 and above. Adding other geriatric syndromes and scores did not improve the model. This information can be used in shared-decision making.

  • 31.
    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

  • 32.
    Engerström, Lars
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Freter, Wolfgang
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Sellgren, Johan
    Sahlgrenska University Hospital, Gothenburg, Sweden; Gothenburg University, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Region Östergötland, Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Faculty of Medicine and Health Sciences, Forum Östergötland.
    Walther, Sten M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Mortality Prediction After Cardiac Surgery: Higgins Intensive Care Unit Admission Score Revisited2020In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 110, no 5, p. 1589-1594Article in journal (Refereed)
    Abstract [en]

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

  • 33.
    Engerström, Lars
    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 Norrköping. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nolin, Thomas
    Central Hospital Kristianstad, Sweden.
    Mårdh, Caroline
    Landstinget Värmland, Sweden.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Karlström, Göran
    Landstinget Varmland, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences, Forum Östergötland.
    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.
    Impact of Missing Physiologic Data on Performance of the Simplified Acute Physiology Score 3 Risk-Prediction Model*2017In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 12, p. 2006-2013Article in journal (Refereed)
    Abstract [en]

    Objectives: The Simplified Acute Physiology 3 outcome prediction model has a narrow time window for recording physiologic measurements. Our objective was to examine the prevalence and impact of missing physiologic data on the Simplified Acute Physiology 3 models performance. Design: Retrospective analysis of prospectively collected data. Setting: Sixty-three ICUs in the Swedish Intensive Care Registry. Patients: Patients admitted during 2011-2014 (n = 107,310). Interventions: None. Measurements and Main Results: Model performance was analyzed using the area under the receiver operating curve, scaled Briers score, and standardized mortality rate. We used a recalibrated Simplified Acute Physiology 3 model and examined model performance in the original dataset and in a dataset of complete records where missing data were generated (simulated dataset). One or more data were missing in 40.9% of the admissions, more common in survivors and low-risk admissions than in nonsurvivors and high-risk admissions. Discrimination did not decrease with one to two missing variables, but accuracy was highest with no missing data. Calibration was best in the original dataset with a mix of full records and records with some missing values (area under the receiver operating curve was 0.85, scaled Brier 27%, and standardized mortality rate 0.99). With zero, one, and two data missing, the scaled Brier was 31%, 26%, and 21%; area under the receiver operating curve was 0.84, 0.87, and 0.89; and standardized mortality rate was 0.92, 1.05 and 1.10, respectively. Datasets where the missing data were simulated for oxygenation or oxygenation and hydrogen ion concentration together performed worse than datasets with these data originally missing. Conclusions: There is a coupling between missing physiologic data, admission type, low risk, and survival. Increased loss of physiologic data reduced model performance and will deflate mortality risk, resulting in falsely high standardized mortality rates.

  • 34.
    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.

  • 35. 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)
  • 36.
    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.

  • 37.
    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.

  • 38.
    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.

  • 39.
    Flaatten, H.
    et al.
    Gen ICU, Norway; University of Bergen, Norway.
    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.
    Activity- or severity-based scoring in the ICU?2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1Article in journal (Other academic)
    Abstract [en]

    n/a

  • 40.
    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

  • 41.
    Flaatten, Hans
    et al.
    Univ Bergen, Norway.
    Guidet, Bertrand
    Sorbonne Univ, France.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Cecconi, Maurizio
    Humanitas Clin & Res Ctr IRCCS, Italy.
    Boumendil, Ariane
    Hop St Antoine, France.
    Elhadi, Muhammed
    Univ Tripoli, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Leaver, Susannah
    St George Hosp, England.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Nalapko, Yuriy
    ICU, Ukraine.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Walther, Sten M.
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Reliability of the Clinical Frailty Scale in very elderly ICU patients: a prospective European study2021In: Annals of Intensive Care, E-ISSN 2110-5820, Vol. 11, no 1, article id 22Article in journal (Refereed)
    Abstract [en]

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

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  • 42.
    Flaatten, Hans
    et al.
    Haukeland Hosp, Norway.
    Guidet, Bertrand
    Sorbonne Univ, France.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Boumendil, Ariane
    Hop St Antoine, France.
    Leaver, Susannah
    St George Hosp, England.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Andersen, Finn
    Alesund Hosp, Norway.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Walther, Sten
    Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Elhadi, Muhammed
    Univ Tripili, Libya.
    Nalapko, Yuriy
    European Wellness Int, Ukraine.
    Fjolner, Jesper
    Viborg Reg Hosp, Denmark.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Consent is a confounding factor in a prospective observational study of critically ill elderly patients2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 10, article id e0276386Article in journal (Refereed)
    Abstract [en]

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

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  • 43.
    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.

  • 44. 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.

  • 45. 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)
  • 46.
    Fronczek, Jakub
    et al.
    Jagiellonian Univ Med Coll, Poland.
    Flaatten, Hans
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Guidet, Bertrand
    UPMC Univ Paris 06, France; Hop St Antoine, France.
    Polok, Kamil
    Jagiellonian Univ Med Coll, Poland.
    Andersen, Finn H.
    Alesund Hosp, Norway; NTNU, Norway.
    Andrew, Benjamin Y.
    Duke Univ, NC 27710 USA.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Beil, Michael
    Hadassah Med Ctr, Israel.
    Cecconi, Maurizio
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Denmark.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Gorka, Jacek
    Jagiellonian Univ Med Coll, Poland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Kusza, Krzysztof
    Poznan Univ Med Sci, Poland.
    Leaver, Susannah
    St George Hosp, England.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Morandi, Alessandro
    Geriatr Res Grp, Italy.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Owczuk, Radoslaw
    Med Univ Gdansk, Poland.
    Agvald-Ohman, Christina
    Karolinska Univ Hosp, Sweden.
    Pinto, Bernardo B.
    Geneva Univ Hosp, Switzerland.
    Rhodes, Andrew
    St Georges Univ Hosp NHS Fdn Trust, England.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Soliman, Ivo W.
    Univ Utrecht, Netherlands.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Austria.
    Walther, Sten
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Linköping University, Department of Health, Medicine and Caring Sciences.
    Watson, Ximena
    St Georges Univ Hosp NHS Fdn Trust, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Short-term mortality or patients >= 80 years old admitted to European intensive care units: an international observational study2022In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 129, no 1, p. 58-66Article in journal (Refereed)
    Abstract [en]

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

  • 47.
    Fronczek, Jakub
    et al.
    Jagiellonian Univ Med Coll, Poland.
    Polok, Kamil
    Jagiellonian Univ Med Coll, Poland.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Beil, Michael
    Hadassah Med Ctr, Israel.
    Rhodes, Andrew
    St Georges Univ Hosp NHS Fdn Trust, England.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Gorka, Jacek
    Jagiellonian Univ Med Coll, Poland.
    Andersen, Finn H.
    Alesund Hosp, Norway; NITNU, Norway.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Cecconi, Maurizio
    Humanitas Clin & Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Denmark.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Leaver, Susannah
    Crit Care Directorate St Georges Hosp, England.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Morandi, Alessandro
    Dept Rehabil Hosp Ancelle Cremona Italy, Italy.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Belgium.
    Agvald-Ohman, Christina
    Karolinska Univ Hosp, Sweden.
    Pinto, Bernardo Bollen
    Geneva Univ Hosp, Switzerland.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Austria.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Watson, Ximena
    St Georges Univ Hosp NHS Fdn Trust, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa, Greece.
    Sviri, Sigal
    Hebrew Univ Jerusalem, Israel; Hebrew Univ Jerusalem, Israel.
    van Heerden, Peter Vernon
    Hebrew Univ Jerusalem, Israel; Hebrew Univ Jerusalem, Israel.
    Flaatten, Hans
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Guidet, Bertrand
    UPMC Univ Paris 06, France.
    Szczeklik, Wojciech
    Jagiellonian Univ Med Coll, Poland.
    Relationship between the Clinical Frailty Scale and short-term mortality in patients >= 80 years old acutely admitted to the ICU: a prospective cohort study2021In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 25, no 1, article id 231Article in journal (Refereed)
    Abstract [en]

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

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  • 48.
    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)
  • 49.
    Guidet, Bertrand
    et al.
    Sorbonne Univ, France.
    de Lange, Dylan W.
    Univ Utrecht, Netherlands.
    Boumendil, Ariane
    Hop St Antoine, France.
    Leaver, Susannah
    Res Lead Crit Care Directorate St Georges Hosp, England.
    Watson, Ximena
    St Georges Univ Hosp, England.
    Boulanger, Carol
    Royal Devon and Exeter NHS Fdn Trust, England.
    Szczeklik, Wojciech
    Jagiellonian Univ, Poland.
    Artigas, Antonio
    Autonomous Univ Barcelona, Spain.
    Morandi, Alessandro
    Hosp Ancelle Cremona Italy, Italy.
    Andersen, Finn
    Alesund Hosp, Norway.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa Tsakal Larissa, Greece.
    Jung, Christian
    Heinrich Heine Univ, Germany.
    Moreno, Rui
    Ctr Hosp Univ Lisboa Cent, Portugal.
    Walther, Sten M.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Oeyen, Sandra
    Univ Ghent, Belgium.
    Schefold, Joerg C.
    Univ Bern, Switzerland.
    Cecconi, Maurizio
    Humanitas Clin and Res Ctr IRCCS, Italy; Humanitas Univ, Italy.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Ireland.
    Joannidis, Michael
    Med Univ Innsbruck, Austria.
    Nalapko, Yuriy
    European Wellness Int, Ukraine.
    Elhadi, Muhammed
    Alkhums Hosp, Libya.
    Fjolner, Jesper
    Aarhus Univ Hosp, Denmark.
    Flaatten, Hans
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study2020In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 46, p. 57-69Article in journal (Refereed)
    Abstract [en]

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

  • 50. 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.

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