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Itenov TS, Kromann ME, Ostrowski SR, Bestle MH, Mohr T, Gyldensted L, Lindhardt A, Thormar K, Sessler DI, Juffermans NP, Lundgren JD, Jensen JU. Mild induced hypothermia and coagulation and platelet function in patients with septic shock: Secondary outcome of a randomized trial. Acta Anaesthesiol Scand 2023. [PMID: 37129236 DOI: 10.1111/aas.14254] [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: 09/22/2022] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Coagulation abnormalities and microthrombi contribute to septic shock, but the impact of body temperature regulation on coagulation in patients with sepsis is unknown. We tested the hypothesis that mild induced hypothermia reduces coagulation and platelet aggregation in patients with septic shock. Secondary analysis of randomized controlled trial. Adult patients with septic shock who required mechanical ventilation from eight intensive care units in Denmark were randomly assigned to mild induced hypothermia for 24 h or routine thermal management. Viscoelastography and platelet aggregation were assessed at trial inclusion, after 12 h of thermal management, and 24 h after inclusion. A total of 326 patients were randomized to mild induced hypothermia (n = 163) or routine thermal management (n = 163). Mild induced hypothermia slightly prolonged activated partial thromboplastin time and thrombus initiation time (R time 8.0 min [interquartile range, IQR 6.6-11.1] vs. 7.2 min [IQR 5.8-9.2]; p = .004) and marginally inhibited thrombus propagation (angle 68° [IQR 59-73] vs. 71° [IQR 63-75]; p = .014). The effect was also present after 24 h. Clot strength remained unaffected (MA 71 mm [IQR 66-76] with mild induced hypothermia vs. 72 mm (65-77) with routine thermal management, p = .9). The proportion of patients with hyperfibrinolysis was not affected (0.7% vs. 3.3%; p = .19), but the proportion of patients with no fibrinolysis was high in the mild hypothermia group (8.8% vs. 40.4%; p < .001). The mild induced hypothermia group had lower platelet aggregation: ASPI 85U (IQR 50-113) versus 109U (IQR 74-148, p < .001), ADP 61U (IQR 40-83) versus 79 U (IQR 54-101, p < .001), TRAP 108 (IQR 83-154) versus 119 (IQR 94-146, p = .042) and COL 50U (IQR 34-66) versus 67U (IQR 46-92, p < .001). In patients with septic shock, mild induced hypothermia slightly impaired clot initiation, but did not change clot strength. Platelet aggregation was slightly impaired. The effect of mild induced hypothermia on viscoelastography and platelet aggregation was however not in a range that would have clinical implications. We did observe a substantial reduction in fibrinolysis.
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Affiliation(s)
- Theis S Itenov
- CHIP/PERSIMUNE, Department of infectious diseases, Rigshospitalet, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Anesthesiology, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria E Kromann
- CHIP/PERSIMUNE, Department of infectious diseases, Rigshospitalet, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Medicine, Faculty of Health sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Clinical Medicine, Faculty of Health sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
| | - Thomas Mohr
- Department of Anesthesiology, Copenhagen University Hospital - Herlev-Gentofte, Copenhagen, Denmark
| | - Louise Gyldensted
- Department of Anesthesiology, Copenhagen University Hospital - Herlev-Gentofte, Copenhagen, Denmark
| | - Anne Lindhardt
- Department of Anesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
| | - Katrin Thormar
- Department of Anesthesiology, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicole P Juffermans
- Department of Intensive Care, OLVG Hospital, Amsterdam, the Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jens D Lundgren
- CHIP/PERSIMUNE, Department of infectious diseases, Rigshospitalet, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik Jensen
- CHIP/PERSIMUNE, Department of infectious diseases, Rigshospitalet, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health sciences, University of Copenhagen, Copenhagen, Denmark
- Respiratory Section, Department of Internal Medicine, Copenhagen University Hospital - Gentofte, Copenhagen, Denmark
- Outcomes Research Consortium, Cleveland, Ohio, USA
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Kjaer MBN, Meyhoff TS, Madsen MB, Hjortrup PB, Møller MH, Egerod I, Wetterslev J, Lange T, Cronhjort M, Laake JH, Jakob SM, Nalos M, Pettilä V, van der Horst ICC, Ostermann M, Mouncey P, Cecconi M, Ferrer R, Malbrain MLNG, Ahlstedt C, Hoffmann S, Bestle MH, Gyldensted L, Nebrich L, Russell L, Vang M, Sølling C, Brøchner AC, Rasmussen BS, Perner A. Long-term patient-important outcomes after septic shock: A protocol for 1-year follow-up of the CLASSIC trial. Acta Anaesthesiol Scand 2020; 64:410-416. [PMID: 31828753 DOI: 10.1111/aas.13519] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with septic shock, mortality is high, and survivors experience long-term physical, mental and social impairments. The ongoing Conservative vs Liberal Approach to fluid therapy of Septic Shock in Intensive Care (CLASSIC) trial assesses the benefits and harms of a restrictive vs standard-care intravenous (IV) fluid therapy. The hypothesis is that IV fluid restriction improves patient-important long-term outcomes. AIM To assess the predefined patient-important long-term outcomes in patients randomised into the CLASSIC trial. METHODS In this pre-planned follow-up study of the CLASSIC trial, we will assess all-cause mortality, health-related quality of life (HRQoL) and cognitive function 1 year after randomisation in the two intervention groups. The 1-year mortality will be collected from electronic patient records or central national registries in most participating countries. We will contact survivors and assess EuroQol 5-Dimension, -5-Level (EQ-5D-5L) and EuroQol-Visual Analogue Scale and Montreal Cognitive Assessment 5-minute protocol score. We will analyse mortality by logistic regression and use general linear models to assess HRQoL and cognitive function. DISCUSSION With this pre-planned follow-up study of the CLASSIC trial, we will provide patient-important data on long-term survival, HRQoL and cognitive function of restrictive vs standard-care IV fluid therapy in patients with septic shock.
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Affiliation(s)
- Maj-Brit N Kjaer
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Tine S Meyhoff
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Martin B Madsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter B Hjortrup
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Jørn Wetterslev
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Cronhjort
- Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Jon H Laake
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Marek Nalos
- Medical Intensive Care Unit, 1. Interni klinika, Fakultni Nemocnice, Plzen, Czech Republic
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Center+, University Maastricht, Maastrict, The Netherlands
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Paul Mouncey
- Clinical Trial Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Maurizio Cecconi
- Department of Intensive Care Medicine, Humanitas Research Hospital, Milan, Italy
| | - Ricard Ferrer
- Department of Intensive Care, Hospital Vall d'Hebron, Barcelona, Spain
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Christian Ahlstedt
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Søren Hoffmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Nordsjaellands Hospital, University Hospital of Copenhagen, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Lene Russell
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Vang
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | - Christoffer Sølling
- Department of Anaesthesia and Intensive Care, Viborg Hospital, Viborg, Denmark
| | - Anne C Brøchner
- Department of Anaesthesia and Intensive Care, Lillebaelt Hospital, Kolding, Denmark
| | - Bodil S Rasmussen
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Centre for Research in Intensive Care (CRIC), Copenhagen, Denmark
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Itenov TS, Johansen ME, Bestle M, Thormar K, Hein L, Gyldensted L, Lindhardt A, Christensen H, Estrup S, Pedersen HP, Harmon M, Soni UK, Perez-Protto S, Wesche N, Skram U, Petersen JA, Mohr T, Waldau T, Poulsen LM, Strange D, Juffermans NP, Sessler DI, Tønnesen E, Møller K, Kristensen DK, Cozzi-Lepri A, Lundgren JD, Jensen JU. Induced hypothermia in patients with septic shock and respiratory failure (CASS): a randomised, controlled, open-label trial. Lancet Respir Med 2018; 6:183-192. [PMID: 29325753 PMCID: PMC10928558 DOI: 10.1016/s2213-2600(18)30004-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Animal models of serious infection suggest that 24 h of induced hypothermia improves circulatory and respiratory function and reduces mortality. We tested the hypothesis that a reduction of core temperature to 32-34°C attenuates organ dysfunction and reduces mortality in ventilator-dependent patients with septic shock. METHODS In this randomised, controlled, open-label trial, we recruited patients from ten intensive care units (ICUs) in three countries in Europe and North America. Inclusion criteria for patients with severe sepsis or septic shock were a mean arterial pressure of less than 70 mm Hg, mechanical ventilation in an ICU, age at least 50 years, predicted length of stay in the ICU at least 24 h, and recruitment into the study within 6 h of fulfilling inclusion criteria. Exclusion criteria were uncontrolled bleeding, clinically important bleeding disorder, recent open surgery, pregnancy or breastfeeding, or involuntary psychiatric admission. We randomly allocated patients 1:1 (with variable block sizes ranging from four to eight; stratified by predictors of mortality, age, Acute Physiology and Chronic Health Evaluation II score, and study site) to routine thermal management or 24 h of induced hypothermia (target 32-34°C) followed by 48 h of normothermia (36-38°C). The primary endpoint was 30 day all-cause mortality in the modified intention-to-treat population (all randomly allocated patients except those for whom consent was withdrawn or who were discovered to meet an exclusion criterion after randomisation but before receiving the trial intervention). Patients and health-care professionals giving the intervention were not masked to treatment allocation, but assessors of the primary outcome were. This trial is registered with ClinicalTrials.gov, number NCT01455116. FINDINGS Between Nov 1, 2011, and Nov 4, 2016, we screened 5695 patients. After recruitment of 436 of the planned 560 participants, the trial was terminated for futility (220 [50%] randomly allocated to hypothermia and 216 [50%] to routine thermal management). In the hypothermia group, 96 (44·2%) of 217 died within 30 days versus 77 (35·8%) of 215 in the routine thermal management group (difference 8·4% [95% CI -0·8 to 17·6]; relative risk 1·2 [1·0-1·6]; p=0·07]). INTERPRETATION Among patients with septic shock and ventilator-dependent respiratory failure, induced hypothermia does not reduce mortality. Induced hypothermia should not be used in patients with septic shock. FUNDING Trygfonden, Lundbeckfonden, and the Danish National Research Foundation.
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Affiliation(s)
- Theis Skovsgaard Itenov
- Department of Anesthesia and Intensive Care, Nordsjællands Hospital, Hillerød, Denmark; Centre of Excellence in Immunity and Infection/Centre of Excellence for Personalised Medicine of Infectious Complications in Immune Deficiency, Department of Infectious Diseases, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Maria Egede Johansen
- Centre of Excellence in Immunity and Infection/Centre of Excellence for Personalised Medicine of Infectious Complications in Immune Deficiency, Department of Infectious Diseases, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Morten Bestle
- Department of Anesthesia and Intensive Care, Nordsjællands Hospital, Hillerød, Denmark
| | - Katrin Thormar
- Department of Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars Hein
- Department of Anesthesia and Intensive Care, Nordsjællands Hospital, Hillerød, Denmark
| | - Louise Gyldensted
- Department of Anesthesia and Intensive Care, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Anne Lindhardt
- Department of Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - Henrik Christensen
- Department of Anesthesia and Intensive Care, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Stine Estrup
- Department of Anesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | | | - Matthew Harmon
- Department of Intensive Care, Academic Medical Center, Amsterdam, Netherlands
| | - Uday Kant Soni
- Department of Anesthesia and Intensive Care, Horsens Hospital, Horsens, Denmark
| | - Silvia Perez-Protto
- Center for Critical Care, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolai Wesche
- Department of Anesthesia and Intensive Care, Nordsjællands Hospital, Hillerød, Denmark
| | - Ulrik Skram
- Department of Anesthesia and Intensive Care, Nordsjællands Hospital, Hillerød, Denmark
| | - John Asger Petersen
- Department of Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - Thomas Mohr
- Department of Anesthesia and Intensive Care, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Tina Waldau
- Department of Anesthesia and Intensive Care, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Lone Musaeus Poulsen
- Department of Anesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Ditte Strange
- Department of Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nicole P Juffermans
- Department of Intensive Care, Academic Medical Center, Amsterdam, Netherlands
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Else Tønnesen
- Department of Anesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Dennis Karsten Kristensen
- Centre of Excellence in Immunity and Infection/Centre of Excellence for Personalised Medicine of Infectious Complications in Immune Deficiency, Department of Infectious Diseases, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Jens D Lundgren
- Centre of Excellence in Immunity and Infection/Centre of Excellence for Personalised Medicine of Infectious Complications in Immune Deficiency, Department of Infectious Diseases, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik Jensen
- Centre of Excellence in Immunity and Infection/Centre of Excellence for Personalised Medicine of Infectious Complications in Immune Deficiency, Department of Infectious Diseases, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark; Respiratory Medicine Division, Department of Internal Medicine, Herlev and Gentofte Hospital, Hellerup, Denmark.
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Itenov TS, Johansen ME, Bestle M, Thormar K, Hein L, Gyldensted L, Lindhardt A, Christensen H, Damby SE, Pedersen HP, Harmon M, Soni UK, Perez-Protto S, Wesche N, Berthelsen RE, Skram U, Petersen A, Mohr T, Waldau T, Poulsen LM, Strange D, Christensen O, Juffermans NP, Sessler D, Tønnesen E, Kristensen D, Cozzi-Lepri A, Lundgren J, Jensen JUS. Induced Hypothermia in Patients with Septic Shock and Ventilator-demanding Respiratory Failure. Open Forum Infect Dis 2017. [PMCID: PMC5631956 DOI: 10.1093/ofid/ofx162.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Animal models of serious infection suggest that 24 hours of induced hypothermia improves circulatory and respiratory characteristics and enhances survival, but whether therapeutic mild hypothermia in such conditions is of clinical benefit remains unknown. We, therefore, tested whether reducing core temperature to 32–34oC in critically ill patients with septic shock and ventilator-demanding respiratory failure improves survival and reduces organ dysfunction. Methods In this multi-national trial, patients with septic shock were enrolled within 6 hours of onset of septic shock and ventilator-demanding respiratory failure and randomized 1:1, stratified by site (target sample = 560), to routine thermal management or 24 hours of induced hypothermia (target 32–34°C) followed by 48 hours of normothermia. Other aspects of care were per routine in each participating center. The primary endpoint was 30-day all-cause mortality. Results At the third ordinary interim analysis, after recruitment of 432 participants, the Data and Safety Monitoring Board recommended the trial be terminated for futility; the conditional power for rejection of the null hypothesis in favor of efficacy was null. In the induced hypothermia group, target temperature was reached within median 3.2 hours [IQR: 2.2, 4.8], and maintained for 24 hours [IQR: 24, 24] (Figure 1). There was no evidence for a difference in 30-day mortality risk in patients randomized to hypothermia (96/217) vs. routine thermal management (77/215): relative risk 1.24 [95% CI: 0.98, 1.56] (Figure 2). At the end of the temperature intervention (72 hours), more patients assigned to hypothermia were in continued shock (vasoactive medication 71% vs. 58%; P = 0.01), and fewer cooled patients had inflammatory control (32% vs. 47% had CRP decline of >30%, P = 0.005). More harm from cooling was seen in patients entering the trial with normal renal function and with normal platelet count (P for interaction < 0.05). Conclusion Among patients with septic shock and ventilator-demanding respiratory failure, induced hypothermia did not improve survival, but adversely affected the duration of shock, and inflammatory control. Induced hypothermia should not routinely be used in patients with septic shock. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Morten Bestle
- Anesthesia and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | - Katrin Thormar
- Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen NW, Denmark
| | - Lars Hein
- Department of Anesthesia and Intensive Care,, North Zealand Hospital, Hillerød, Denmark
| | - Louise Gyldensted
- Anesthesia and Intensive Care, Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Anne Lindhardt
- Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen NW, Denmark
| | - Henrik Christensen
- Anesthesia & Intensive Care, Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Stine Estrup Damby
- Anesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | | | - Matthew Harmon
- Anesthesia and Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
| | - Uday Kant Soni
- Anesthesia and Intensive Care, Horsens Hospital, Horsens, Denmark
| | | | - Nikolaj Wesche
- Anesthesia and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | | | - Ulrik Skram
- Anesthesia and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | - Asger Petersen
- Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen NW, Denmark
| | - Thomas Mohr
- Anesthesia and Intensive Care, Gentofte Hospital, Hellerup, Denmark
| | - Tina Waldau
- Anesthesia & Intensive Care, Herlev & Gentofte Hospital, Hellerup, Denmark
| | | | - Ditte Strange
- Anesthesia and Intensive Care, Bispebjerg Hospital, Copenhagen NW, Denmark
| | - Ole Christensen
- Anesthesia and Intensive Care, Roskilde Hospital, Roskilde, Denmark
| | - Nicole P Juffermans
- Anesthesia and Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Else Tønnesen
- Anesthesia and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Dennis Kristensen
- Chip/Department of Infectious Diseases, Rigshospitalet – University of Copenhagen, Copenhagen East, Denmark
| | - Alessandro Cozzi-Lepri
- Chip/Department of Infectious Diseases, Rigshospitalet – University of Copenhagen, Copenhagen East, Denmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Chip/Department of Infectious Diseases, Rigshospitalet – University of Copenhagen , Copehagen East, Denmark
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Eskildsen SF, Gyldensted L, Nagenthiraja K, Hansen MB, Dalby RB, Frandsen J, Rodell A, Gyldensted C, Jespersen SN, Mouridsen K, Brændgaard H, Østergaard L. IC‐04‐01: Cortical capillary dysfunction in patients suspected of Alzheimer's disease. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Eskildsen SF, Gyldensted L, Nagenthiraja K, Hansen MB, Dalby RB, Frandsen J, Rodell A, Gyldensted C, Jespersen SN, Mouridsen K, Brændgaard H, Østergaard L. P4‐062: Cortical capillary dysfunction in patients suspected of Alzheimer's disease. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eskildsen SF, Gyldensted L, Nagenthiraja K, Hansen M, Dalby R, Frandsen J, Rodell A, Gyldensted C, Jespersen SN, Mouridsen K, Brændgaard H, Østergaard L. IC‐P‐154: CAPILLARY TRANSIT TIME HETEROGENEITY IN THE CEREBRUM CORRELATE WITH COGNITIVE DECLINE IN AD. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eskildsen SF, Gyldensted L, Nagenthiraja K, Hansen M, Dalby R, Frandsen J, Rodell A, Gyldensted C, Jespersen SN, Mouridsen K, Brændgaard H, Østergaard L. P1‐239: CAPILLARY TRANSIT TIME HETEROGENEITY IN THE CEREBRUM CORRELATE WITH COGNITIVE DECLINE IN AD. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eskildsen S, Gyldensted L, Nagenthiraja K, Frandsen J, Rodell A, Gyldensted C, Jespersen SN, Mouridsen K, Brændgaard H, Østergaard L. P1–318: Increased oxygen extraction capacity in the basal ganglia and thalamus of patients with Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eskildsen S, Gyldensted L, Nagenthiraja K, Frandsen J, Rodell A, Gyldensted C, Jespersen SN, Mouridsen K, Brændgaard H, Østergaard L. IC‐P‐176: Increased oxygen extraction capacity in the basal ganglia and thalamus of people with Alzheimer's disease. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Christensen PS, Pedersen BB, Gulisano H, Gyldensted L, Nielsen HI. [Cerebral manifestations of influenza A (H1N1)v]. Ugeskr Laeger 2010; 172:3345-3346. [PMID: 21118668] [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: 05/30/2023]
Abstract
We describe two patients with cerebral manifestations of influenza A (H1N1)v. A 13-year-old boy developed severe cerebral oedema and increased intracranial pressure despite medical treatment and external drainage of cerebrospinal fluid. He was treated with bifrontal decompressive craniectomy with good result. A 25-year-old man with a previous kidney transplant developed encephalopathy and convulsions. Magnetic resonance imaging showed encephalitis. The patient fully recovered. The cases demonstrate that influenza A (H1N1)v can cause seriously and potentially life-threatening neurological complications.
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Mouridsen K, Friston K, Hjort N, Gyldensted L, Østergaard L, Kiebel S. Bayesian estimation of cerebral perfusion using a physiological model of microvasculature. Neuroimage 2006; 33:570-9. [PMID: 16971140 DOI: 10.1016/j.neuroimage.2006.06.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 06/07/2006] [Accepted: 06/18/2006] [Indexed: 11/29/2022] Open
Abstract
Perfusion weighted MRI has proven very useful for deriving hemodynamic parameters such as CBF, CBV and MTT. These quantities are important diagnostically, e.g. in acute stroke, where they are used to delineate ischemic regions. Yet the standard method for estimating CBF based on singular value decomposition (SVD) has been demonstrated to underestimate (especially high) flow components and to be sensitive to delays in the arterial input function (AIF). Furthermore, the estimated residue functions often oscillate. This compromises their physiological interpretation/basis and makes estimation of related measures such as flow heterogeneity difficult. In this study, we estimate perfusion parameters based on a vascular model (VM) which represents heterogeneous capillary flow and explicitly leads to monotonically decreasing residue functions. We use a fully Bayesian approach to obtain posterior probability distributions for all parameters. In simulation studies, we show that the VM method has less bias in CBF estimates than the SVD based method for realistic SNRs. This also applies to cases where the AIF is delayed. We employ our method to estimate perfusion maps using data from (i) a healthy volunteer and (ii) from a stroke patient.
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Affiliation(s)
- Kim Mouridsen
- Department of Neuroradiology, Centre of Functionally Integrative Neuroscience, Building 30, Arhus University Hospital, Nørrebrogade 44, DK-8000 Arhus C, Denmark.
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Gyldensted L, Mouridsen K, Rodell A, Østergaard L, Gyldensted C. P2–354: Contrast bolus magnetic resonance imaging in Alzheimer's disease and mild cognitive impairment. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Louise Gyldensted
- Dep. of NeuroradiologyAarhus University HospitalAarhusDenmark
- CFIN, Aarhus University HospitalAarhusDenmark
| | - Kim Mouridsen
- Dep. of NeuroradiologyAarhus University HospitalAarhusDenmark
- CFIN, Aarhus University HospitalAarhusDenmark
| | | | - Leif Østergaard
- Dep. of NeuroradiologyAarhus University HospitalAarhusDenmark
- CFIN, Aarhus University HospitalAarhusDenmark
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Abstract
Quantification of cerebral blood flow (CBF) using dynamic susceptibility contrast MRI requires determination of the arterial input function (AIF) representing the delivery of intravascular tracer to tissue. This is typically accomplished manually by inspection of concentration time curves (CTCs) in regions containing the ICA, VA, and MCA. This is, however, a time consuming and operator dependent procedure. We suggest a completely automatic procedure for establishing the AIF based on a cluster analysis algorithm. In 20 normal subjects CBF maps calculated in 2 slices by the automatic procedure were compared to maps obtained with AIFs selected individually by 7 experienced operators. The average manual to automatic CBF ratio was 1.03+/-0.15 in the lower slice and 1.05+/-0.12 in the upper slice, demonstrating excellent agreement between the manual and automatic method. The algorithm provides means for objectively assessing AIF candidates in local AIF search algorithms designed to reduce bias due to delay and dispersion. Given the reproducibility and speed (10 s) of the automatic method, we speculate that it will greatly improve the accuracy of perfusion images and facilitate their use in clinical diagnosis and decision-making, particularly in acute stroke but also in cerebrovascular disease in general.
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Affiliation(s)
- Kim Mouridsen
- Centre for Functionally Integrative Neuroscience (CFIN), Department of Neuroradiology, Arhus University Hospital, Denmark.
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