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Garioud ALDB, Andersen LPK, Jensen AKG, Do HQ, Jakobsen JC, Holst LB, Rasmussen LS, Afshari A. Intravenous MELAtonin for prevention of Postoperative Agitation and Emergence Delirium in children (MELA-PAED): A protocol and statistical analysis plan for a randomized clinical trial. Acta Anaesthesiol Scand 2024; 68:280-286. [PMID: 37904610 DOI: 10.1111/aas.14342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Emergence agitation and delirium in children remain a common clinical challenge in the post-anesthetic care unit. Preoperative oral melatonin has been suggested as an effective preventive drug with a favorable safety profile. The oral bioavailability of melatonin, however, is low. Therefore, the MELA-PAED trial aims to investigate the efficacy and safety of intraoperative intravenous melatonin for the prevention of emergence agitation in pediatric surgical patients. METHODS MELA-PAED is a randomized, double-blind, parallel two-arm, multi-center, superiority trial comparing intravenous melatonin with placebo. Four hundred participants aged 1-6 years will be randomized 1:1 to either the intervention or placebo. The intervention consists of intravenous melatonin 0.15 mg/kg administered approximately 30 min before the end of surgery. Participants will be monitored in the post-anesthetic care unit (PACU), and the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) will be performed on days 1, 7, and 14 after the intervention. Serious Adverse Events (SAE) will be assessed up to 30 days after the intervention. RESULTS The primary outcome is the incidence of emergence agitation, assessed dichotomously as any Watcha score >2 during the participant's stay in the post-anesthetic care unit. Secondary outcomes are opioid consumption in the post-anesthetic care unit and adverse events. Exploratory outcomes include SAEs, postoperative pain, postoperative nausea and vomiting, and time to awakening, to first oral intake, and to discharge readiness. CONCLUSION The MELA-PAED trial investigates the efficacy of intravenous intraoperative melatonin for the prevention of emergence agitation in pediatric surgical patients. Results may provide further knowledge concerning the use of melatonin in pediatric perioperative care.
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Affiliation(s)
- Anne Louise de Barros Garioud
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peter Kloster Andersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Aksel Karl Georg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hien Quoc Do
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Broksø Holst
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Arash Afshari
- Department of Anesthesiology, Juliane Marie Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Køster A, Fernandez AV, Meyhoff CS, Andersen LPK. Intensive care nurses' experiences of caring for isolated COVID-positive patients during first wave of COVID-19. J Intensive Care Soc 2023; 24:379-385. [PMID: 37841301 PMCID: PMC10111162 DOI: 10.1177/17511437231160073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background COVID-19 has fundamentally changed all fields of health care. Intensive care nurses have been at the forefront of the pandemic facing the massive impact of the disease, both professionally and personally. This study investigated nurses' experiences of caring for isolated COVID-19 positive patients in the intensive care department during the first wave of the COVID-19 pandemic. The study investigated how isolation affected the nurses themselves, how they related with their patients, and how isolation affected patient care in general. Methods The study was performed at a 20-bed university hospital intensive care department in Copenhagen, Denmark. COVID-19 positive patients were isolated or cohort isolated. A dedicated nurse cared for each isolated patient and wore full personal protective equipment. The study is based on in-depth phenomenological interviews with intensive care nurses conducted in summer 2020. The interviews were structured according to the principles of "Phenomenologically Grounded Qualitative Research." The data included observations from within the isolated patient rooms. Findings Six intensive care nurses participated in the study. The analysis documented following themes consistently reported by all nurses: (1) a general sense of uncanniness, (2) intense feelings of confinement and co-isolation, and (3) heightened senses of bodily objectification, including how nurses' experienced their patients and also themselves. Conclusion This is the first Scandinavian phenomenological study to focus on mapping the experiences of intensive care nurses during the extreme circumstances of the first wave of the COVID-19 pandemic. Further studies may explore long-term effects, such as psychiatric morbidity or psychological functioning in these individuals.
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Affiliation(s)
- Allan Køster
- The Danish National Center for Grief, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anthony Vincent Fernandez
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peter Kloster Andersen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Stehr-Pingel L, Maagaard M, Tvarnø CD, Andersen LPK, Andersen JH, Mathiesen O. Remimazolam for sedation: A protocol for a systematic review with meta-analysis, trial sequential analysis, and GRADE approach. Acta Anaesthesiol Scand 2023; 67:1432-1438. [PMID: 37580880 DOI: 10.1111/aas.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/07/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Procedural sedation aims to facilitate a successful diagnostic or therapeutic procedure. The pharmacokinetic properties and pharmacodynamic effects need to be taken into consideration when choosing the ideal sedative. Midazolam and propofol are frequently employed. However, they are associated with respiratory depression with increasing dosage. Also, midazolam has a potentially unpredictable pharmacodynamic response and propofol may cause hypotension and injection site pain. Remimazolam may provide a superior alternative due to its rapid pharmacodynamic profile and insignificant circulatory effects. METHODS This protocol employs the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The review aims to assess the beneficial and harmful clinical effects of remimazolam versus placebo or other sedatives in adult patients requiring sedation in relation to a diagnostic or therapeutic procedure, or due to other circumstances. Three primary outcomes are identified: Sedation success rate, respiratory complications, and hemodynamic complications. Six secondary outcomes are identified: among these are quality of recovery and serious adverse events. All randomized trials are included. The search strategy includes six major biomedical databases. Literature screening and data extraction will be performed independently by two authors. Risk of systemic error will be assessed with Risk of Bias 2 Tool. Risk of random error will be assessed with trial sequential analysis. Heterogeneity will be evaluated by appropriate statistical tests. The certainty of the evidence will be judged using Grading of Recommendations Assessment, Development, and Evaluation. Meta-analysis will be carried out with Rstudio. A "Summary of Findings" table will be presented with our primary and secondary outcome results. DISCUSSION The systematic review with up-to-date methodology outlined in this protocol investigates the clinical effects of remimazolam in relation to procedural sedation. The results may guide clinicians in the clinical use of remimazolam.
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Affiliation(s)
- Lasse Stehr-Pingel
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Casper Duevang Tvarnø
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Lars Peter Kloster Andersen
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Jakob Hessel Andersen
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Centre for Anaesthesiological Research, Department of Anaesthesia, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Køster A, Meyhoff CS, Andersen LPK. Experiences of isolation in patients in the intensive care unit during the COVID-19 pandemic. Acta Anaesthesiol Scand 2023; 67:1061-1068. [PMID: 37246341 DOI: 10.1111/aas.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/05/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, patients in the intensive care unit have been subjected to strict isolation precautions, and potentially long and complicated patient courses. The aim of the study is to provide an investigation of the experiences of isolation in COVID-19-positive patients in the ICU during the first phase of the COVID-19 pandemic in Denmark. METHODS The study was performed in a 20-bed ICU at a university hospital in Copenhagen, Denmark. The study is based on a phenomenological framework, Phenomenologically Grounded Qualitative Research. This approach provides insights into the tacit, pre-reflective and embodied dimensions of the specific experience under investigation. Methods included a combination of in-depth structured interviews with ICU patients 6-12 months after ICU discharge, and observations from inside the isolated patient rooms. The descriptions of experiences gathered through the interviews were subjected to systematic thematic analysis. RESULTS Twenty-nine patients were admitted to the ICU in the period 10 March and 19 May 2020. A total of six patients was included in the study. Themes consistently reported across all patients included (1) being objectified to degrees that implied self-alienation; (2) feeling a sense of being in captivity; (3) being in an experiential state of surrealism, and finally (4) experiencing extreme loneliness and intercorporeal deprivation. CONCLUSION This study provided further insights into the liminal patient experiences of being isolated in the ICU due to COVID-19. Robust themes of experience were achieved through an in-depth phenomenological approach. Although, similarities in experiences compared to other patient groups exist, the precarious situation constituted by COVID-19 lead to significant intensifications across multiple parameters.
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Affiliation(s)
- Allan Køster
- The Danish National Center for Grief, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peter Kloster Andersen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Haase N, Plovsing R, Christensen S, Poulsen LM, Brøchner AC, Rasmussen BS, Helleberg M, Jensen JUS, Andersen LPK, Siegel H, Ibsen M, Jørgensen VL, Winding R, Iversen S, Pedersen HP, Madsen J, Sølling C, Garcia RS, Michelsen J, Mohr T, Michagin G, Espelund US, Bundgaard H, Kirkegaard L, Smitt M, Buck DL, Ribergaard NE, Pedersen HS, Christensen BV, Nielsen LP, Clapp E, Jonassen TB, Weihe S, la Cour K, Nielsen FM, Madsen EK, Haberlandt TN, Meier N, Perner A. Changes over time in characteristics, resource use and outcomes among ICU patients with COVID-19 - a nationwide, observational study in Denmark. Acta Anaesthesiol Scand 2022; 66:987-995. [PMID: 35781689 PMCID: PMC9544552 DOI: 10.1111/aas.14113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/01/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Characteristics and care of ICU patients with COVID-19 may have changed during the pandemic, but longitudinal data assessing this are limited. We compared patients with COVID-19 admitted to Danish ICUs in the first wave with those admitted later. METHODS Among all Danish ICU patients with COVID-19, we compared demographics, chronic comorbidities, use of organ support, length of stay and vital status of those admitted 10th March to 19th May 2020 (first wave) versus 20th May 2020 to 30th June 2021. We analysed risk factors for death by adjusted logistic regression analysis. RESULTS Among all hospitalised patients with COVID-19, a lower proportion was admitted to ICU after the first wave (13 vs 8%). Among all 1374 ICU patients with COVID-19, 326 were admitted during the first wave. There were no major differences in patient's characteristics or mortality between the two periods, but use of invasive mechanical ventilation (81% vs 58% of patients), renal replacement therapy (26% vs. 13%) and ECMO (8% vs 3%) and median length of stay in ICU (13 vs 10 days) and in hospital (20 vs 17 days) were all significantly lower after the first wave. Risk factors for death were higher age, larger burden of co-morbidity (hearth failure, pulmonary disease, and kidney disease), and active cancer, but not admission during or after the first wave. CONCLUSIONS After the first wave of COVID-19 in Denmark, a lower proportion of hospitalised patients with COVID-19 was admitted to ICU. Among ICU patients, use of organ support was lower and length of stay was reduced, but mortality rates remained at a relatively high level. EDITORIAL COMMENT This study assessed the temporal changes in the care of patients with COVID-19 requiring ICU care in Denmark. The findings showed that while a lower ratio of patients with documented infections required ICU and they required less organ support, ICU mortality remained unchanged. This might reflect the effects of vaccines on disease severity and improvement in floor management of hypoxic patients, but also underscores that COVID-19 remains a serious threat to the health of many patients, in particularly elderly patients with a high degree of comorbidity.
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Affiliation(s)
- Nicolai Haase
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ronni Plovsing
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | | | | | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Hanna Siegel
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Michael Ibsen
- Department of Anaesthesiology and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | | | - Robert Winding
- Department of Anaesthesiology and Intensive Care, Herning Hospital, Herning, Denmark
| | - Susanne Iversen
- Department of Anaesthesiology and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Henrik Planck Pedersen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Jacob Madsen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Christoffer Sølling
- Department of Anaesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
| | | | - Jens Michelsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Thomas Mohr
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - George Michagin
- Department of Anaesthesiology and Intensive Care, Svendborg Hospital, Svendborg, Denmark
| | | | - Helle Bundgaard
- Department of Anaesthesiology and Intensive Care, Randers Hospital, Randers, Denmark
| | - Lynge Kirkegaard
- Department of Anaesthesiology and Intensive Care, Åbenrå Hospital, Åbenrå, Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - David Levarett Buck
- Department of Anaesthesiology and Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Niels-Erik Ribergaard
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Helle Scharling Pedersen
- Department of Anaesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | - Lone Pia Nielsen
- Department of Anaesthesiology and Intensive Care, Bornholms Hospital, Rønne, Denmark
| | - Esben Clapp
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Trine Bak Jonassen
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Sarah Weihe
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Kirstine la Cour
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | | | - Emilie Kabel Madsen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | | | - Nick Meier
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
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Sørensen KM, Olesen C, Meyhoff CS, Andersen LPK. The use of melatonin in Danish intensive care departments-A nationwide observational study. Acta Anaesthesiol Scand 2022; 66:833-837. [PMID: 35583851 DOI: 10.1111/aas.14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melatonin is widely employed as a hypnotic in various patient groups. In intensive care patients, melatonin seems to be increasingly used due to potential clinical effects and a favourable safety profile. OBJECTIVES We aimed to investigate the extend of usage and clinical practice of melatonin therapy in intensive care departments in Denmark. DESIGN Data from regional hospital pharmacies and the Danish Intensive Care Database were used to estimate defined daily dose and defined daily dose per 1000 ICU admission days. Also, related expenses in the period 2015-2019. Finally, a questionnaire describing the clinical practice of melatonin therapy was provided to all Danish intensive care departments. PRINCIPAL OBSERVATIONS The usage of melatonin in intensive care departments in Denmark increased from 21,300 DDD (200.0 DDD per 1000 ICU admission days) in 2015 to 52,170 DDD (560.7 DDD per 1000 ICU admission days) in 2019. A total of 32 ICU departments participated in the study (97% of all Danish ICU departments). All included ICU departments employed melatonin as a hypnotic. Nineteen percent of included departments administered melatonin to all admitted patients, whereas 25% of departments rarely administered melatonin. Magistral melatonin 3-mg tablets was the most employed drug dose/formulation. Increased doses of melatonin were administered in selected patients. Melatonin was considered safe by prescribing clinicians. CONCLUSIONS Melatonin is widely and increasingly used in Danish intensive care departments. The more than doubled usage of melatonin in the study period advocates for further studies employing validated outcomes of sleep and other patient-relevant outcomes. EDITORIAL COMMENT This study documents that melatonin is frequently used as a hypnotic in Danish intensive care units during recent years despite a shortage of reliable evidence to support a recommendation to treat with melatonin in this context. These results support a need for conducting clinical trials to determine whether or not there is a beneficial effect of melatonin treatment in critically ill patients.
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Affiliation(s)
- Kasper Mørk Sørensen
- Department of Anaesthesia and Intensive Care Copenhagen University Hospital ‐ Bispebjerg and Frederiksberg Copenhagen Denmark
| | | | - Christian Sylvest Meyhoff
- Department of Anaesthesia and Intensive Care Copenhagen University Hospital ‐ Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Peter Kloster Andersen
- Department of Anaesthesia and Intensive Care Copenhagen University Hospital ‐ Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Springborg AD, Wessel CR, Andersen LPK, Werner MU. Methodology and applicability of the human contact burn injury model: A systematic review. PLoS One 2021; 16:e0254790. [PMID: 34329326 PMCID: PMC8323928 DOI: 10.1371/journal.pone.0254790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
The contact burn injury model is an experimental contact thermode-based physiological pain model primarily applied in research of drug efficacy in humans. The employment of the contact burn injury model across studies has been inconsistent regarding essential methodological variables, challenging the validity of the model. This systematic review analyzes methodologies, outcomes, and research applications of the contact burn injury model. Based on these results, we propose an improved contact burn injury testing paradigm. A literature search was conducted (15-JUL-2020) using PubMed, EMBASE, Web of Science, and Google Scholar. Sixty-four studies were included. The contact burn injury model induced consistent levels of primary and secondary hyperalgesia. However, the analyses revealed variations in the methodology of the contact burn injury heating paradigm and the post-burn application of test stimuli. The contact burn injury model had limited testing sensitivity in demonstrating analgesic efficacy. There was a weak correlation between experimental and clinical pain intensity variables. The data analysis was limited by the methodological heterogenicity of the different studies and a high risk of bias across the studies. In conclusion, although the contact burn injury model provides robust hyperalgesia, it has limited efficacy in testing analgesic drug response. Recommendations for future use of the model are being provided, but further research is needed to improve the sensitivity of the contact burn injury method. The protocol for this review has been published in PROSPERO (ID: CRD42019133734).
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Affiliation(s)
- Anders Deichmann Springborg
- Department of Anesthesia, Multidisciplinary Pain Center, Pain and Respiratory Support, Neuroscience Center, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Caitlin Rae Wessel
- Department of Physiology, University of Kentucky, Lexington, KY, United States of America
| | - Lars Peter Kloster Andersen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mads Utke Werner
- Department of Anesthesia, Multidisciplinary Pain Center, Pain and Respiratory Support, Neuroscience Center, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Haase N, Plovsing R, Christensen S, Poulsen LM, Brøchner AC, Rasmussen BS, Helleberg M, Jensen JUS, Andersen LPK, Siegel H, Ibsen M, Jørgensen V, Winding R, Iversen S, Pedersen HP, Madsen J, Sølling C, Garcia RS, Michelsen J, Mohr T, Mannering A, Espelund US, Bundgaard H, Kirkegaard L, Smitt M, Buck DL, Ribergaard N, Pedersen HS, Christensen BV, Perner A. Characteristics, interventions, and longer term outcomes of COVID-19 ICU patients in Denmark-A nationwide, observational study. Acta Anaesthesiol Scand 2021; 65:68-75. [PMID: 32929715 DOI: 10.1111/aas.13701] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most data on intensive care unit (ICU) patients with COVID-19 originate in selected populations from stressed healthcare systems with shorter term follow-up. We present characteristics, interventions and longer term outcomes of the entire, unselected cohort of all ICU patients with COVID-19 in Denmark where the ICU capacity was not exceeded. METHODS We identified all patients with SARS-CoV-2 admitted to any Danish ICU from 10 March to 19 May 2020 and registered demographics, chronic comorbidities, use of organ support, length of stay, and vital status from patient files. Risk factors for death were analyzed using adjusted Cox regression analysis. RESULTS There were 323 ICU patients with confirmed COVID-19. Median age was 68 years, 74% were men, 50% had hypertension, 21% diabetes, and 20% chronic pulmonary disease; 29% had no chronic comorbidity. Invasive mechanical ventilation was used in 82%, vasopressors in 83%, renal replacement therapy in 26%, and extra corporeal membrane oxygenation in 8%. ICU stay was median 13 days (IQR 6-22) and hospital stay 19 days (11-30). Median follow-up was 79 days. At end of follow-up, 118 had died (37%), 15 (4%) were still in hospital hereof 4 in ICU as of 16 June 2020. Risk factors for mortality included male gender, age, chronic pulmonary disease, active cancer, and number of co-morbidities. CONCLUSIONS In this nationwide, population-based cohort of ICU patients with COVID-19, longer term survival was high despite high age and substantial use of organ support. Male gender, age, and chronic co-morbidities, in particular chronic pulmonary disease, were associated with increased risk of death.
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Affiliation(s)
- Nicolai Haase
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
| | - Ronni Plovsing
- Department of Anesthesiology and Intensive Care Hvidovre Hospital Copenhagen Denmark
| | - Steffen Christensen
- Department of Anesthesiology and Intensive Care Århus University Hospital Århus Denmark
| | - Lone Musaeus Poulsen
- Department of Anesthesiology and Intensive Care Zealand University Hospital Køge Denmark
| | | | - Bodil Steen Rasmussen
- Department of Anesthesiology and Intensive Care Ålborg University Hospital Ålborg Denmark
| | - Marie Helleberg
- Department of Infectious Diseases Rigshospitalet Copenhagen Denmark
| | | | | | - Hanna Siegel
- Department of Anesthesiology and Intensive Care Herlev‐Gentofte Hospital Copenhagen Denmark
| | - Michael Ibsen
- Department of Anesthesiology and Intensive Care North Zealand Hospital Hillerød Denmark
| | - Vibeke Jørgensen
- Department of Cardiothoracic Anesthesiology Rigshospitalet Copenhagen Denmark
| | - Robert Winding
- Department of Anesthesiology and Intensive Care Herning Hospital Herning Denmark
| | - Susanne Iversen
- Department of Anesthesiology and Intensive Care Slagelse Hospital Slagelse Denmark
| | - Henrik Planck Pedersen
- Department of Anesthesiology and Intensive Care Zealand University Hospital Roskilde Denmark
| | - Jacob Madsen
- Department of Anesthesiology and Intensive Care Ålborg University Hospital Ålborg Denmark
| | - Christoffer Sølling
- Department of Anesthesiology and Intensive Care Viborg Hospital Viborg Denmark
| | | | - Jens Michelsen
- Department of Anesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Thomas Mohr
- Department of Anesthesiology and Intensive Care Herlev‐Gentofte Hospital Copenhagen Denmark
| | - Anne Mannering
- Department of Anesthesiology and Intensive Care Svendborg Hospital Svendborg Denmark
| | | | - Helle Bundgaard
- Department of Anesthesiology and Intensive Care Randers Hospital Randers Denmark
| | - Lynge Kirkegaard
- Department of Anesthesiology and Intensive Care Åbenrå Hospital Åbenrå Denmark
| | - Margit Smitt
- Department of Neuroanesthesiology Rigshospitalet Copenhagen Denmark
| | - David Levarett Buck
- Department of Anesthesiology and Intensive Care Holbæk Hospital Holbæk Denmark
| | | | - Helle Scharling Pedersen
- Department of Anesthesiology and Intensive Care Nykøbing Falster Hospital Nykøbing Falster Denmark
| | | | - Anders Perner
- Department of Intensive Care Rigshospitalet Copenhagen Denmark
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Zetner D, Andersen LPK, Alder R, Jessen ML, Tolstrup A, Rosenberg J. Pharmacokinetics and Safety of Intravenous, Intravesical, Rectal, Transdermal, and Vaginal Melatonin in Healthy Female Volunteers: A Cross-Over Study. Pharmacology 2020; 106:169-176. [PMID: 32937627 DOI: 10.1159/000510252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to investigate the pharmacokinetic properties and safety of melatonin administered by alternative routes of administration. METHODS This study employed a cross-over design in healthy female volunteers. Twenty-five milligrams of melatonin was administered intravenously, intravesically, rectally, transdermally, and vaginally. Blood samples were collected at specified time points up to 24 h following intravenous, intravesical, rectal, and vaginal administration, and up to 48 h following transdermal administration. Plasma melatonin concentrations were determined by radioimmunoassay. Sedation was evaluated by a simple reaction-time test, and sleepiness was assessed by the Karolinska Sleepiness Scale. Adverse events were registered for each route of administration. RESULTS Ten participants were included. We documented a mean (SD) time to maximal concentration of 51 (29) min for intravesical, 24 (20) min for rectal, 21 (8) h for transdermal, and 147 (56) min for vaginal administration. The mean (SD) elimination half-life was 47 (6) min for intravenous, 58 (7) min for intravesical, 60 (18) min for rectal, 14.6 (11.1) h for transdermal, and 129 (17) min for vaginal administration. The mean (SD) bioavailability was 3.6 (1.9)% for intravesical, 36.0 (28.6)% for rectal, 10.0 (5.7)% for transdermal, and 97.8 (31.7)% for vaginal administration. No significant changes in reaction times were observed following administration of melatonin by any of the administration routes. Increased tiredness was documented following transdermal administration only. No serious adverse effects were documented. CONCLUSION Rectally and vaginally administered melatonin may serve as relevant alternatives to standard oral melatonin therapy. Transdermal delivery of melatonin displayed an extended absorption and can be applied if prolonged effects are intended. Intravesical administration displayed, as expected, a very limited bioavailability. Melatonin administered by these routes of administration was safe.
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Affiliation(s)
- Dennis Zetner
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark,
| | | | - Rasmus Alder
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Majken Lyhne Jessen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders Tolstrup
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Wissenberg M, Andersen LPK, Pallisgaard JL, Lawson-Smith P. [Fatal outcome of coronavirus disease 2019 in a previously healthy 50-year-old man]. Ugeskr Laeger 2020; 182:V03200196. [PMID: 32286213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this case report, a 50-year-old man who had no medical history, presented with multiple cardiac arrests following a week with progressing symptoms of pneumonia. After achieving return of spontaneous circulation he presented with respiratory failure with severe hypoxia, septic shock, and multiple organ failure. A chest X-ray showed signs of acute respiratory distress syndrome. Despite aggressive intensive care management, the patient died 7.5 hours after admission. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was later confirmed, and the presumed cause of death was SARS-CoV-2 pneumonia. In conclusion: coronavirus disease 2019 (COVID-19) can lead to a fatal outcome in younger healthy residents, who are not treated timely in case of severe symptoms like dyspnoea.
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Harpsøe NG, Andersen LPK, Mielke LV, Jønsson B, Jenstrup MT, Gögenur I, Rosenberg J. Pharmacokinetics of Repeated Melatonin Drug Administrations Prior to and After Surgery. Clin Drug Investig 2016; 36:1045-1050. [DOI: 10.1007/s40261-016-0452-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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