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Wihersaari L, Reinikainen M, Furlan R, Mandelli A, Vaahersalo J, Kurola J, Tiainen M, Pettilä V, Bendel S, Varpula T, Latini R, Ristagno G, Skrifvars MB. Neurofilament light compared to neuron-specific enolase as a predictor of unfavourable outcome after out-of-hospital cardiac arrest. Resuscitation 2022; 174:1-8. [PMID: 35245610 DOI: 10.1016/j.resuscitation.2022.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/13/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
AIM We compared the prognostic abilities of neurofilament light (NfL) and neuron-specific enolase (NSE) in patients resuscitated from out-of-hospital cardiac arrest (OHCA) of various aetiologies. METHODS We analysed frozen blood samples obtained at 24 and 48 hours from OHCA patients treated in 21 Finnish intensive care units in 2010 and 2011. We defined unfavourable outcome as Cerebral Performance Category (CPC) 3-5 at 12 months after OHCA. We evaluated the prognostic ability of the biomarkers by calculating the area under the receiver operating characteristic curves (AUROCs [95% confidence intervals]) and compared these with a bootstrap method. RESULTS Out of 248 adult patients, 12-month outcome was unfavourable in 120 (48.4%). The median (interquartile range) NfL concentrations for patients with unfavourable and those with favourable outcome, respectively, were 688 (146-1804) pg/mL vs. 31 (17-61) pg/mL at 24 h and 1162 (147-4361) pg/mL vs. 36 (21-87) pg/mL at 48 h, p < 0.001 for both. The corresponding NSE concentrations were 13.3 (7.2-27.3) µg/L vs. 8.5 (5.8-13.2) µg/L at 24 h and 20.4 (8.1-56.6) µg/L vs. 8.2 (5.9-12.1) µg/L at 48 h, p < 0.001 for both. The AUROCs to predict an unfavourable outcome were 0.90 (0.86-0.94) for NfL vs. 0.65 (0.58-0.72) for NSE at 24 h, p < 0.001 and 0.88 (0.83-0.93) for NfL and 0.73 (0.66-0.81) for NSE at 48 h, p < 0.001. CONCLUSION Compared to NSE, NfL demonstrated superior accuracy in predicting long-term unfavourable outcome after OHCA.
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Affiliation(s)
- L Wihersaari
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
| | - M Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - R Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - A Mandelli
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - J Vaahersalo
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Kurola
- Centre for Prehospital Emergency Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - M Tiainen
- University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - V Pettilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - T Varpula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - R Latini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M B Skrifvars
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Laurén E, Vikatmaa L, Kerkelä E, Kivipuro T, Krusius T, Syrjälä M, Ihalainen J, Pettilä V. Red blood cell transfusion in southern Finland from 2011 to 2016: a quality audit. Transfus Med 2018; 29:41-47. [DOI: 10.1111/tme.12568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023]
Affiliation(s)
- E. Laurén
- Finnish Red Cross Blood Service; Helsinki Finland
- Department of Anesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - L. Vikatmaa
- Department of Anesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - E. Kerkelä
- Finnish Red Cross Blood Service; Helsinki Finland
| | - T. Kivipuro
- Finnish Red Cross Blood Service; Helsinki Finland
| | - T. Krusius
- Finnish Red Cross Blood Service; Helsinki Finland
| | - M. Syrjälä
- Finnish Red Cross Blood Service; Helsinki Finland
| | - J. Ihalainen
- Finnish Red Cross Blood Service; Helsinki Finland
| | - V. Pettilä
- Department of Anesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Laake JH, Tønnessen TI, Chew MS, Lipcsey M, Hjelmqvist H, Wilkman E, Pettilä V, Hoffmann‐Petersen J, Møller MH. The SSAI fully supports the suspension of hydroxyethyl-starch solutions commissioned by the European Medicines Agency. Acta Anaesthesiol Scand 2018; 62:874-875. [PMID: 29658984 PMCID: PMC6690069 DOI: 10.1111/aas.13120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- J. H. Laake
- Department of Anaesthesiology Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - T. I. Tønnessen
- Department of Anaesthesiology Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - M. S. Chew
- Department of Anaesthesia and Intensive Care Medical and Health Sciences Linköping University Linköping Sweden
| | - M. Lipcsey
- Hedenstierna laboratory Department of Surgical Sciences Anaesthesiology and Intensive Care CIRRUS Uppsala University Hospital Uppsala Sweden
| | - H. Hjelmqvist
- School of Medical Sciences Department of Anaesthesia and Intensive Care Örebro University and University Hospital Örebro Sweden
| | - E. Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - V. Pettilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - J. Hoffmann‐Petersen
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - M. H. Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Kuuliala K, Penttilä AK, Kaukonen KM, Mustonen H, Kuuliala A, Oiva J, Hämäläinen M, Moilanen E, Pettilä V, Puolakkainen P, Kylänpää L, Repo H. Signalling Profiles of Blood Leucocytes in Sepsis and in Acute Pancreatitis in Relation to Disease Severity. Scand J Immunol 2017; 87:88-98. [DOI: 10.1111/sji.12630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022]
Affiliation(s)
- K. Kuuliala
- Department of Bacteriology and Immunology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. K. Penttilä
- Department of GI surgery; Abdominal Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - K.-M. Kaukonen
- Department of Anesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - H. Mustonen
- Department of GI surgery; Abdominal Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. Kuuliala
- Department of Bacteriology and Immunology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - J. Oiva
- Department of Surgery; Kuopio University Hospital; Kuopio Finland
| | - M. Hämäläinen
- The Immunopharmacology Research Group; Faculty of Medicine and Life Sciences; University of Tampere and Tampere University Hospital; Tampere Finland
| | - E. Moilanen
- The Immunopharmacology Research Group; Faculty of Medicine and Life Sciences; University of Tampere and Tampere University Hospital; Tampere Finland
| | - V. Pettilä
- Department of Anesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - P. Puolakkainen
- Department of GI surgery; Abdominal Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - L. Kylänpää
- Department of GI surgery; Abdominal Centre; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - H. Repo
- Department of Bacteriology and Immunology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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5
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Mårtensson J, Vaara ST, Pettilä V, Ala-Kokko T, Karlsson S, Inkinen O, Uusaro A, Larsson A, Bell M. Assessment of plasma endostatin to predict acute kidney injury in critically ill patients. Acta Anaesthesiol Scand 2017; 61:1286-1295. [PMID: 28857121 DOI: 10.1111/aas.12988] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/12/2017] [Accepted: 08/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND We evaluated whether plasma endostatin predicts acute kidney injury (AKI), need for renal replacement therapy (RRT), or death. METHODS Prospective, observational, multicenter study from 1 September 2011 to 1 February 2012 with data from 17 intensive care units (ICUs) in Finland. RESULTS A total of 1112 patients were analyzed. We measured plasma endostatin within 2 h of ICU admission. Early AKI (KDIGO stage within 12 h of ICU admission) was found in 20% of the cohort, and 18% developed late AKI (KDIGO criteria > 12 h from ICU admission). Median (IQR) admission endostatin was higher in the early AKI group, 29 (19.1, 41.9) ng/ml as compared to 22.4 (16.1, 30.1) ng/ml for the late AKI group, and 18 (14.0, 23.6) ng/ml for non-AKI patients (P < 0.001). Endostatin level increased with increasing KDIGO stage. Significantly higher endostatin levels were found in patients with sepsis as compared to those without. Predictive properties for AKI, RRT, and mortality were low with corresponding areas under the receiver operating characteristic curve (AUC) of 0.62, 0.67, and 0.59. Sensitivity analyses among patients with chronic kidney disease or sepsis did not improve the predictive ability of endostatin. Adding endostatin to a clinical AKI prediction model (illness severity score, urine output, and age) insignificantly changed the AUC from 0.67 to 0.70 (P = 0.14). CONCLUSIONS Endostatin increases with AKI severity but has limited value as a predictor of AKI, RRT and 90-day mortality in patients admitted to ICU. Moreover, endostatin does not improve AKI risk prediction when added to a clinical risk model.
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Affiliation(s)
- J. Mårtensson
- Perioperative Medicine and Intensive Care; Department of Physiology and Pharmacology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
- Department of Intensive Care; Austin Hospital; Heidelberg Vic. Australia
| | - S. T. Vaara
- Department of Intensive Care; Austin Hospital; Heidelberg Vic. Australia
- Intensive Care Medicine; Department of Anesthesiology; Intensive Care and Pain Medicine; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - V. Pettilä
- Intensive Care Medicine; Department of Anesthesiology; Intensive Care and Pain Medicine; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - T. Ala-Kokko
- Medical Research Center; Research Group of Surgery, Anesthesia and Intensive Care; University of Oulu; Oulu Finland
- Department of Anesthesiology; Division of Intensive Care; Oulu University Hospital; Oulu Finland
| | - S. Karlsson
- Intensive Care Medicine; Tampere University Hospital; University of Tampere; Tampere Finland
| | - O. Inkinen
- Intensive Care; Turku University Hospital; Turku Finland
| | - A. Uusaro
- Intensive Care; Kuopio University Hospital; Kuopio Finland
| | - A. Larsson
- Department of Medical Sciences, Clinical Chemistry; Uppsala University; Uppsala Sweden
| | - M. Bell
- Perioperative Medicine and Intensive Care; Department of Physiology and Pharmacology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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Forni LG, Darmon M, Ostermann M, Oudemans-van Straaten HM, Pettilä V, Prowle JR, Schetz M, Joannidis M. Renal recovery after acute kidney injury. Intensive Care Med 2017; 43:855-866. [PMID: 28466146 PMCID: PMC5487594 DOI: 10.1007/s00134-017-4809-x] [Citation(s) in RCA: 267] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/17/2017] [Indexed: 12/20/2022]
Abstract
Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality, chronic kidney disease (CKD) and cardiovascular events. The degree of renal recovery from AKI may substantially affect these long-term endpoints. Therefore maximising recovery of renal function should be the goal of any AKI prevention and treatment strategy. Defining renal recovery is far from straightforward due in part to the limitations of the tests available to assess renal function. Here, we discuss common pitfalls in the evaluation of renal recovery and provide suggestions for improved assessment in the future. We review the epidemiology of renal recovery and of the association between AKI and the development of CKD. Finally, we stress the importance of post-discharge follow-up of AKI patients and make suggestions for its incorporation into clinical practice. Summary key points are that risk factors for non-recovery of AKI are age, CKD, comorbidity, higher severity of AKI and acute disease scores. Second, AKI and CKD are mutually related and seem to have a common denominator. Third, despite its limitations full recovery of AKI may best be defined as the absence of AKI criteria, and partial recovery as a fall in AKI stage. Fourth, after an episode of AKI, serial follow-up measurements of serum creatinine and proteinuria are warranted to diagnose renal impairment and prevent further progression. Measures to promote recovery are similar to those preventing renal harm. Specific interventions promoting repair are still experimental.
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Affiliation(s)
- L G Forni
- Intensive Care Unit and Surrey Perioperative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, UK.,Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - M Darmon
- Medical-Surgical ICU, Hopital Nord, CHU Saint-Etienne, Ave. Albert Raimon, 42270 Saint-Prient-en-Jarez, EA3065, Saint-Etienne, France
| | - M Ostermann
- Department of Critical Care and Nephrology, Guy's and St Thomas' Hospital, London, SE1 9RT, UK
| | - H M Oudemans-van Straaten
- Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - V Pettilä
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J R Prowle
- William Harvey Research Institute, Queen Mary University of London and Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
| | - M Schetz
- Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Herestraat 49, 3000, Louvain, Belgium
| | - M Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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7
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Rob D, Špunda R, Lindner J, Šmalcová J, Šmíd O, Kovárník T, Linhart A, Bìlohlávek J, Marinoni MM, Cianchi G, Trapani S, Migliaccio ML, Gucci L, Bonizzoli M, Cramaro A, Cozzolino M, Valente S, Peris A, Grins E, Kort E, Weiland M, Shresta NM, Davidson P, Algotsson L, Fitch S, Marco G, Sturgill J, Lee S, Dickinson M, Boeve T, Khaghani A, Wilton P, Jovinge S, Ahmad AN, Loveridge R, Vlachos S, Patel S, Gelandt E, Morgan L, Butt S, Whitehorne M, Kakar V, Park C, Hayes M, Willars C, Hurst T, Best T, Vercueil A, Auzinger G, Adibelli B, Akovali N, Torgay A, Zeyneloglu P, Pirat A, Kayhan Z, Schmidbauer SS, Herlitz J, Karlsson T, Friberg H, Knafelj R, Radsel P, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Maka M, Ollieuz S, Reychler G, Mosaddegh R, Abbasi S, Talaee S, Zotzmann VZ, Staudacher DS, Wengenmayer TW, Dürschmied DD, Bode CB, Nelskylä A, Nurmi J, Jousi M, Schramko A, Mervaala E, Ristagno G, Skrifvars M, Ozsoy G, Kendirli T, Azapagasi E, Perk O, Gadirova U, Ozcinar E, Cakici M, Baran C, Durdu S, Uysalel A, Dogan M, Ramoglu M, Ucar T, Tutar E, Atalay S, Akar R, Kamps M, Leeuwerink G, Hofmeijer J, Hoiting O, Van der Hoeven J, Hoedemaekers C, Konkayev A, Kuklin V, Kondratyev T, Konkayeva M, Akhatov N, Sovershaev M, Tveita T, Dahl V, Wihersaari L, Skrifvars MB, Bendel S, Kaukonen KM, Vaahersalo J, Romppanen J, Pettilä V, Reinikainen M, Lybeck A, Cronberg T, Nielsen N, Friberg H, Rauber M, Steblovnik K, Jazbec A, Noc M, Kalasbail P, Garrett F, Kulstad E, Bergström DJ, Olsson HR, Schmidbauer S, Friberg H, Mandel I, Mikheev S, Podoxenov Y, Suhodolo I, Podoxenov A, Svirko J, Sementsov A, Maslov L, Shipulin V, Vammen LV, Rahbek SR, Secher NS, Povlsen JP, Jessen NJ, Løfgren BL, Granfeldt AG, Grossestreuer A, Perman S, Patel P, Ganley S, Portmann J, Cocchi M, Donnino M, Nassar Y, Fathy S, Gaber A, Mokhtar S, Chia YC, Lewis-Cuthbertson R, Mustafa K, Sabra A, Evans A, Bennett P, Eertmans W, Genbrugge C, Boer W, Dens J, De Deyne C, Jans F, Skorko A, Thomas M, Casadio M, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G, Moon JB, Cho JH, Park CW, Ohk TG, Shin MC, Won MH, Papamichalis P, Zisopoulou V, Dardiotis E, Karagiannis S, Papadopoulos D, Zafeiridis T, Babalis D, Skoura A, Staikos I, Komnos A, Passos SS, Maeda F, Souza LS, Filho AA, Granjeia TAG, Schweller M, Franci D, De Carvalho Filho M, Santos TM, De Azevedo P, Wall R, Welters I, Tansuwannarat P, Sanguanwit P, Langer T, Carbonara M, Caccioppola A, Fusarini CF, Carlesso E, Paradiso E, Battistini M, Cattaneo E, Zadek F, Maiavacca R, Stocchetti N, Pesenti A, Ramos A, Acharta F, Toledo J, Perezlindo M, Lovesio L, Dogliotti A, Lovesio C, Schroten N, Van der Veen B, De Vries MC, Veenstra J, Abulhasan YB, Rachel S, Châtillon-Angle M, Alabdulraheem N, Schiller I, Dendukuri N, Angle M, Frenette C, Lahiri S, Schlick K, Mayer SA, Lyden P, Akatsuka M, Arakawa J, Yamakage M, Rubio J, Mateo-Sidron JAR, Sierra R, Celaya M, Benitez L, Alvarez-Ossorio S, Rubio J, Mateo-Sidron JAR, Sierra R, Fernandez A, Gonzalez O, Engquist H, Rostami E, Enblad P, Toledo J, Ramos A, Acharta F, Canullo L, Nallino J, Dogliotti A, Lovesio C, Perreault M, Talic J, Frenette AJ, Burry L, Bernard F, Williamson DR, Adukauskiene D, Cyziute J, Adukauskaite A, Malciene L, Luca L, Rogobete A, Bedreag O, Papurica M, Sarandan M, Cradigati C, Popovici S, Vernic C, Sandesc D, Avakov V, Shakhova I, Trimmel H, Majdan M, Herzer GH, Sokoloff CS, Albert M, Williamson D, Odier C, Giguère J, Charbonney E, Bernard F, Husti Z, Kaptás T, Fülep Z, Gaál Z, Tusa M, Donnelly J, Aries M, Czosnyka M, Robba C, Liu M, Ercole A, Menon D, Hutchinson P, Smielewski P, López R, Graf J, Montes JM, Kenawi M, Kandil A, Husein K, Samir A, Heijneman J, Huijben J, Abid-Ali F, Stolk M, Van Bommel J, Lingsma H, Van der Jagt M, Cihlar RC, Mancino G, Bertini P, Forfori F, Guarracino F, Pavelescu D, Grintescu I, Mirea L, Alamri S, Tharwat M, Kono N, Okamoto H, Uchino H, Ikegami T, Fukuoka T, Simoes M, Trigo E, Coutinho P, Pimentel J, Franci A, Basagni D, Boddi M, Cozzolino M, Anichini V, Cecchi A, Peris A, Markopoulou D, Venetsanou K, Papanikolaou I, Barkouri T, Chroni D, Alamanos I, Cingolani E, Bocci MG, Pisapia L, Tersali A, Cutuli SL, Fiore V, Palma A, Nardi G, Antonelli M, Coke R, Kwong A, Dwivedi DJ, Xu M, McDonald E, Marshall JC, Fox-Robichaud AE, Charbonney E, Liaw PC, Kuchynska I, Malysh IR, Zgrzheblovska LV, Mestdagh L, Verhoeven EF, Hubloue I, Ruel-laliberte J, Zarychanski R, Lauzier F, Bonaventure PL, Green R, Griesdale D, Fowler R, Kramer A, Zygun D, Walsh T, Stanworth S, Léger C, Turgeon AF, Baron DM, Baron-Stefaniak J, Leitner GC, Ullrich R, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Pérez AG, Silva J, Artemenko V, Bugaev A, Tokar I, Konashevskaya S, Kolesnikova IM, Roitman EV, Kiss TR, Máthé Z, Piros L, Dinya E, Tihanyi E, Smudla A, Fazakas J, Ubbink R, Boekhorst te P, Mik E, Caneva L, Ticozzelli G, Pirrelli S, Passador D, Riccardi F, Ferrari F, Roldi EM, Di Matteo M, Bianchi I, Iotti GA, Zurauskaite G, Voegeli A, Meier M, Koch D, Haubitz S, Kutz A, Bargetzi M, Mueller B, Schuetz P, Von Meijenfeldt G, Van der Laan M, Zeebregts C, Christopher KB, Vernikos P, Melissopoulou T, Kanellopoulou G, Panoutsopoulou M, Xanthis D, Kolovou K, Kypraiou T, Floros J, Broady H, Pritchett C, Marshman M, Jannaway N, Ralph C, Lehane CL, Keyl CK, Zimmer EZ, Trenk DT, Ducloy-Bouthors AS, Jonard MJ, Fourrier F, Piza F, Correa T, Marra A, Guerra J, Rodrigues R, Vilarinho A, Aranda V, Shiramizo S, Lima MR, Kallas E, Cavalcanti AB, Donoso M, Vargas P, Graf J, McCartney J, Ramsay S, McDowall K, Novitzky-Basso I, Wright C, Medic MG, Bielen L, Radonic V, Zlopasa O, Vrdoljak NG, Gasparovic V, Radonic R, Narváez G, Cabestrero D, Rey L, Aroca M, Gallego S, Higuera J, De Pablo R, González LR, Chávez GN, Lucas JH, Alonso DC, Ruiz MA, Valarezo LJ, De Pablo Sánchez R, Real AQ, Wigmore TW, Bendavid I, Cohen J, Avisar I, Serov I, Kagan I, Singer P, Hanison J, Mirza U, Conway D, Takasu A, Tanaka H, Otani N, Ohde S, Ishimatsu S, Coffey F, Dissmann P, Mirza K, Lomax M, Dissmann P, Coffey F, Mirza K, Lomax M, Miner JR, Leto R, Markota AM, Gradišek PG, Aleksejev VA, Sinkovič AS, Romagnoli S, Chelazzi C, Zagli G, Benvenuti F, Mancinelli P, Boninsegni P, Paparella L, Bos AT, Thomas O, Goslar T, Knafelj R, Perreault M, Martone A, Sandu PR, Rosu VA, Capilnean A, Murgoi P, Frenette AJ, Lecavalier A, Jayaraman D, Rico P, Bellemare P, Gelinas C, Williamson D, Nishida T, Kinoshita T, Iwata N, Yamakawa K, Fujimi S, Maggi L, Sposato F, Citterio G, Bonarrigo C, Rocco M, Zani V, De Blasi RA, Alcorn D, Barry L, Riedijk MA, Milstein DM, Caldas J, Panerai R, Camara L, Ferreira G, Bor-Seng-Shu E, Lima M, Galas F, Mian N, Nogueira R, de Oliveira GQ, Almeida J, Jardim J, Robinson TG, Gaioto F, Hajjar LA, Zabolotskikh I, Musaeva T, Saasouh W, Freeman J, Turan A, Saseedharan S, Pathrose E, Poojary S, Messika J, Martin Y, Maquigneau N, Henry-Lagarrigue M, Puechberty C, Stoclin A, Martin-Lefevre L, Blot F, Dreyfuss D, Dechanet A, Hajage D, Ricard J, Almeida E, Almeida J, Landoni G, Galas F, Fukushima J, Fominskiy E, De Brito C, Cavichio L, Almeida L, Ribeiro U, Osawa E, Boltes R, Battistella L, Hajjar L, Fontela P, Lisboa T, Junior LF, Friedman GF, Abruzzi F, Primo JAP, Filho PM, de Andrade JS, Brenner KM, boeira MS, Leães C, Rodrigues C, Vessozi A, Machado AS, Weiler M, Bryce H, Hudson A, Law T, Reece-Anthony R, Molokhia A, Abtahinezhadmoghaddam F, Cumber E, Channon L, Wong A, Groome R, Gearon D, Varley J, Wilson A, Reading J, Wong A, Zampieri FG, Bozza FA, Ferez M, Fernandes H, Japiassú A, Verdeal J, Carvalho AC, Knibel M, Salluh JI, Soares M, Gao J, Ahmadnia E, Patel B, McCartney J, MacKay A, Binning S, Wright C, Pugh RJ, Battle C, Hancock C, Harrison W, Szakmany T, Mulders F, Vandenbrande J, Dubois J, Stessel B, Siborgs K, Ramaekers D, Soares M, Silva UV, Homena WS, Fernandes GC, Moraes AP, Brauer L, Lima MF, De Marco F, Bozza FA, Salluh JI, Maric N, Mackovic M, Udiljak N, Bosso CE, Caetano RD, Cardoso AP, Souza OA, Pena R, Mescolotte MM, Souza IA, Mescolotte GM, Bangalore H, Borrows E, Barnes D, Ferreira V, Azevedo L, Alencar G, Andrade A, Bierrenbach A, Buoninsegni LT, Bonizzoli M, Cecci L, Cozzolino M, Peris A, Lindskog J, Rowland K, Sturgess P, Ankuli A, Molokhia A, Rosa R, Tonietto T, Ascoli A, Madeira L, Rutzen W, Falavigna M, Robinson C, Salluh J, Cavalcanti A, Azevedo L, Cremonese R, Da Silva D, Dornelles A, Skrobik Y, Teles J, Ribeiro T, Eugênio C, Teixeira C, Zarei M, Hashemizadeh H, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Lignos M, Crissanthopoulou E, Flevari K, Dimopoulos P, Armaganidis A, Golub JG, Markota AM, Stožer AS, Sinkovič AS, Rüddel H, Ehrlich C, Burghold CM, Hohenstein C, Winning J, Sellami W, Hajjej Z, Bousselmi M, Gharsallah H, Labbene I, Ferjani M, Sattler J, Steinbrunner D, Poppert H, Schneider G, Blobner M, Kanz KG, Schaller SJ, Apap K, Xuereb G, Xuereb G, Apap K, Massa L, Xuereb G, Apap K, Massa L, Delvau N, Penaloza A, Liistro G, Thys F, Delattre IK, Hantson P, Roy PM, Gianello P, Hadîrcă L, Ghidirimschi A, Catanoi N, Scurtov N, Bagrinovschi M, Sohn YS, Cho YC, Golovin B, Creciun O, Ghidirimschi A, Bagrinovschi M, Tabbara R, Whitgift JZ, Ishimaru A, Yaguchi A, Akiduki N, Namiki M, Takeda M, Tamminen JN, Reinikainen M, Uusaro A, Taylor CG, Mills ED, Mackay AD, Ponzoni C, Rabello R, Serpa A, Assunção M, Pardini A, Shettino G, Corrêa T, Vidal-Cortés PV, Álvarez-Rocha L, Fernández-Ugidos P, Virgós-Pedreira A, Pérez-Veloso MA, Suárez-Paul IM, Del Río-Carbajo L, Fernández SP, Castro-Iglesias A, Butt A, Alghabban AA, Khurshid SK, Ali ZA, Nizami IN, Salahuddin NS, Alshahrani M, Alsubaie AW, Alshamsy AS, Alkhiliwi BA, Alshammari HK, Alshammari MB, Telmesani NK, Alshammari RB, Asonto LP, Zampieri FG, Damiani LP, Bozza F, Salluh JI, Cavalcanti AB, El Khattate A, Bizrane M, Madani N, Belayachi J, Abouqal R, Ramnarain D, Gouw-Donders B, Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A, Taniguchi LU, Araujo L, Salgado G, Vieira JM, Viana J, Ziviani N, Pessach I, Lipsky A, Nimrod A, O´Connor M, Matot I, Segal E, Kluzik A, Gradys A, Smuszkiewicz P, Trojanowska I, Cybulski M, De Jong A, Sebbane M, Chanques G, Jaber S, Rosa R, Robinson C, Bessel M, Cavalheiro L, Madeira L, Rutzen W, Oliveira R, Maccari J, Falavigna M, Sanchez E, Dutra F, Dietrich C, Balzano P, Rezende J, Teixeira C, Sinha S, Majhi K, Gorlicki JG, Pousset FP, Kelly J, Aron J, Gilbert AC, Urankar NP, Knafelj R, Irazabal M, Bosque M, Manciño J, Kotsopoulos A, Jansen N, Abdo W, Casey ÚM, O’Brien B, Plant R, Doyle B. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3). Crit Care 2017. [PMCID: PMC5374552 DOI: 10.1186/s13054-017-1630-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pettilä V, Jakob SM, Takala J. The new sepsis/septic shock-3 definition is just not enough - more detailed research is needed. Acta Anaesthesiol Scand 2016; 60:1344-1346. [PMID: 27699785 DOI: 10.1111/aas.12777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- V. Pettilä
- Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
- Division of Intensive Care Medicine; Department of Anesthesiology, Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. M. Jakob
- Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - J. Takala
- Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
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Ollila A, Vikatmaa L, Virolainen J, Vikatmaa P, Leppäniemi A, Albäck A, Salmenperä M, Pettilä V. Perioperative Myocardial Infarction in Non-Cardiac Surgery Patients: A Prospective Observational Study. Scand J Surg 2016; 106:180-186. [DOI: 10.1177/1457496916673585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials. Material and Methods: We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment. Results: Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery—19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non–perioperative myocardial infarction patients ( p < 0.001). Perioperative risk calculator predicted perioperative myocardial infarction with an area under curve of 0.73 (95% confidence interval: 0.64–0.81). Conclusion: Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.
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Affiliation(s)
- A. Ollila
- Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L. Vikatmaa
- Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J. Virolainen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P. Vikatmaa
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A. Leppäniemi
- Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A. Albäck
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M. Salmenperä
- Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - V. Pettilä
- Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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la Gandara AM, Gonzalo G, Lopez MA, de Gopegui Miguelena PR, Matilla CIB, Chueca PS, Longares MDCR, Martínez MG, Abril RR, Aguilar ALR, de Murillas RGL, Fernández RF, Laborías PM, Castellanos MAD, Laborías MEM, Cho J, Kim J, Park J, Sánchez RJ, Woo S, West T, Powell E, Rimmer A, Orford C, Jones N, Williams J, Matilla CIB, de Gopegui Miguelena PR, Chueca PS, Gascón LM, Abril RR, Longares MDCR, Aguilar ALR, de Murillas RGL, Bourne RS, Shulman R, Tomlin M, Mills GH, Borthwick M, Berry W, Mulero MDR, Huertas DG, Manzano F, Villagrán-Ramírez F, Ruiz-Perea A, Rodríguez-Mejías C, Santiago-Ruiz F, Colmenero-Ruiz M, König C, Matt B, Kortgen A, Freire AO, Hartog CS, Wong A, Balan C, Barker G, Srisawat N, Peerapornratana S, Laoveeravat P, Tachaboon S, Eiam-ong S, Paratz J, Muñoz AO, Kayambu G, Boots R, Arzapalo MFA, Vlasenko R, Gromova E, Loginov S, Kiselevskiy M, Dolgikova Y, Tang KB, Chau CM, Acebes SR, Lam KN, Gil E, Suh GY, Park CM, Park J, Chung CR, Lee CT, Chao A, Shih PY, Chang YF, Martínez ÁF, Lai CH, Hsu YC, Yeh YC, Cheng YJ, Colella V, Zarrillo N, D’Amico M, Forfori F, Pezza B, Laddomada T, Aliaga SM, Beltramelli V, Pizzaballa ML, Doronzio A, Balicco B, Kiers D, van der Heijden W, Gerretsen J, de Mast Q, el Messaoudi S, Rongen G, Para LH, Gomes M, Kox M, Pickkers P, Riksen NP, Kashiwagi Y, Okada M, Hayashi K, Inagaki Y, Fujita S, Nakamae MN, Payá JM, Kang YR, Souza RB, Liberatore AMA, Koh IHJ, Blet A, Sadoune M, Lemarié J, Bihry N, Bern R, Polidano E, Mulero FR, Merval R, Launay JM, Lévy B, Samuel JL, Mebazaa A, Hartmann J, Harm S, Weber V, Guerci P, Ince Y, Heeman P, Ergin B, Ince C, Uz Z, Massey M, Ince Y, Papatella R, Bulent E, Guerci P, Toraman F, Ince C, Longbottom ER, Torrance HD, Owen HC, Hinds CJ, Pearse RM, O’Dywer MJ, Trogrlic Z, van der Jagt M, Lingsma H, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, van Achterberg T, Bakker J, Gommers DAMPJ, Ista E, Krajčová A, Waldauf P, Duška F, Shah A, Roy N, McKechnie S, Doree C, Fisher S, Stanworth SJ, Jensen JF, Overgaard D, Bestle MH, Christensen DF, Egerod I, Pivkina A, Gusarov V, Zhivotneva I, Pasko N, Zamyatin M, Jensen JF, Egerod I, Bestle MH, Christensen DF, Alklit A, Hansen RL, Knudsen H, Grode LB, Overgaard D, Hravnak M, Chen L, Dubrawski A, Clermont G, Pinsky MR, Parry SM, Knight LD, Connolly BC, Baldwin CE, Puthucheary ZA, Denehy L, Hart N, Morris PE, Mortimore J, Granger CL, Jensen HI, Piers R, Van den Bulcke B, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje E, Vanheule S, Azoulay E, Vansteelandt S, Benoit D, Ryan C, Dawson D, Ball J, Noone K, Aisling B, Prudden S, Ntantana A, Matamis D, Savvidou S, Giannakou M, Gouva M, Nakos G, Koulouras V, Aron J, Lumley G, Milliken D, Dhadwal K, McGrath BA, Lynch SJ, Bovento B, Sharpe G, Grainger E, Pieri-Davies S, Wallace S, McGrath B, Lynch SJ, Bovento B, Grainger E, Pieri-Davies S, Sharpe G, Wallace S, Jung M, Cho J, Park H, Suh G, Kousha O, Paddle J, Gripenberg LG, Rehal MS, Wernerman J, Rooyackers O, de Grooth HJ, Choo WP, Spoelstra-de Man AM, Swart EL, Oudemans-van Straaten HM, Talan L, Güven G, Altıntas ND, Padar M, Uusvel G, Starkopf L, Starkopf J, Blaser AR, Kalaiselvan MS, Arunkumar AS, Renuka MK, Shivkumar RL, Volbeda M, ten Kate D, Hoekstra M, van der Maaten JM, Nijsten MW, Komaromi A, Rooyackers O, Wernerman J, Norberg Å, Smedberg M, Mori M, Pettersson L, Norberg Å, Rooyackers O, Wernerman J, Theodorakopoulou M, Christodoulopoulou T, Diamantakis A, Frantzeskaki F, Kontogiorgi M, Chrysanthopoulou E, Lygnos M, Diakaki C, Armaganidis A, Gundogan K, Dogan E, Coskun R, Muhtaroglu S, Sungur M, Ziegler T, Guven M, Kleyman A, Khaliq W, Andreas D, Singer M, Meierhans R, Schuepbach R, De Brito-Ashurst I, Zand F, Sabetian G, Nikandish R, Hagar F, Masjedi M, Maghsudi B, Vazin A, Ghorbani M, Asadpour E, Kao KC, Chiu LC, Hung CY, Chang CH, Li SH, Hu HC, El Maraghi S, Ali M, Rageb D, Helmy M, Marin-Corral J, Vilà C, Masclans JR, Vàzquez A, Martín-Loeches I, Díaz E, Yébenes JC, Rodriguez A, Álvarez-Lerma F, Varga N, Cortina-Gutiérrez A, Dono L, Martínez-Martínez M, Maldonado C, Papiol E, Pérez-Carrasco M, Ferrer R, Nweze K, Morton B, Welters I, Houard M, Voisin B, Ledoux G, Six S, Jaillette E, Nseir S, Romdhani S, Bouneb R, Loghmari D, Aicha NB, Ayachi J, Meddeb K, Chouchène I, Khedher A, Boussarsar M, Chan KS, Yu WL, Marin-Corral J, Vilà C, Masclans JR, Nolla J, Vidaur L, Bonastre J, Suberbiola B, Guerrero JE, Rodriguez A, Coll NR, Jiménez GJ, Brugger SC, Calero JC, Garrido BB, García M, Martínez MP, Vidal MV, de la Torre MC, Vendrell E, Palomera E, Güell E, Yébenes JC, Serra-Prat M, Bermejo-Martín JF, Almirall J, Tomas E, Escoval A, Froe F, Pereira MHV, Velez N, Viegas E, Filipe E, Groves C, Reay M, Chiu LC, Hu HC, Hung CY, Chang CH, Li SH, Kao KC, Ballin A, Facchin F, Sartori G, Zarantonello F, Campello E, Radu CM, Rossi S, Ori C, Simioni P, Umei N, Shingo I, Santos AC, Candeias C, Moniz I, Marçal R, e Silva ZC, Ribeiro JM, Georger JF, Ponthus JP, Tchir M, Amilien V, Ayoub M, Barsam E, Martucci G, Panarello G, Tuzzolino F, Capitanio G, Ferrazza V, Carollo T, Giovanni L, Arcadipane A, Sánchez ML, González-Gay MA, Díaz FJL, López MIR, Zogheib E, Villeret L, Nader J, Bernasinski M, Besserve P, Caus T, Dupont H, Morimont P, Habran S, Hubert R, Desaive T, Blaffart F, Janssen N, Guiot J, Pironet A, Dauby P, Lambermont B, Zarantonello F, Ballin A, Facchin F, Sartori G, Campello E, Pettenuzzo T, Citton G, Rossi S, Simioni P, Ori C, Kirakli C, Ediboglu O, Ataman S, Yarici M, Tuksavul F, Keating S, Gibson A, Gilles M, Dunn M, Price G, Young N, Remeta P, Bishop P, Zamora MDF, Muñoz-Bono J, Curiel-Balsera E, Aguilar-Alonso E, Hinojosa R, Gordillo-Brenes A, Arboleda-Sánchez JA, Skorniakov I, Vikulova D, Whiteley C, Shaikh O, Jones A, Ostermann M, Forni L, Scott M, Sahatjian J, Linde-Zwirble W, Hansell D, Laoveeravat P, Srisawat N, Kongwibulwut M, Peerapornrattana S, Suwachittanont N, Wirotwan TO, Chatkaew P, Saeyub P, Latthaprecha K, Tiranathanagul K, Eiam-ong S, Kellum JA, Berthelsen RE, Perner A, Jensen AEK, Jensen JU, Bestle MH, Gebhard DJ, Price J, Kennedy CE, Akcan-Arikan A, Liberatore AMA, Souza RB, Martins AMCRPF, Vieira JCF, Kang YR, Nakamae MN, Koh IHJ, Hamed K, Khaled MM, Soliman RA, Mokhtar MS, Seller-Pérez G, Arias-Verdú D, Llopar-Valdor E, De-Diós-Chacón I, Quesada-García G, Herrera-Gutierrez ME, Hafes R, Carroll G, Doherty P, Wright C, Vera IGG, Ralston M, Gemmell ML, MacKay A, Black E, Wright C, Docking RI, Appleton R, Ralston MR, Gemmell L, Appleton R, Wright C, Docking RI, Black E, Mackay A, Rozemeijer S, Mulier JLGH, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Marttinen M, Wilkman E, Petäjä L, Suojaranta-Ylinen R, Pettilä V, Vaara ST. Association of plasma chloride values with acute kidney injury in the critically ill - a prospective observational study. Acta Anaesthesiol Scand 2016; 60:790-9. [PMID: 26866628 DOI: 10.1111/aas.12694] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/17/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chloride-rich fluids have been found to associate with an increased risk for acute kidney injury (AKI) among intensive care unit (ICU) patients. Studies evaluating the association of plasma chloride (Cl) with the development of AKI are few. We hypothesized that higher plasma Cl is associated with an increased risk for the development of AKI. METHODS In this sub-study of the prospective FINNAKI study, we analyzed Cl values measured during ICU stay in two ICUs at a tertiary center including 445 patients. We calculated time-weighted mean values within the first 24 h in ICU for plasma Cl (ClTWM 24 ). We analyzed the association of ClTWM 24 primarily with the development of AKI, and secondarily with 90-day mortality. RESULTS Based on the first measured Cl value, 350 of 445 patients [78.7 (95 CI, 74.8-82.5)] had hyperchloremia (P-Cl > 106 mmol/l) and 48 [10.8 (95 CI, 7.9-13.7)] severe hyperchloremia (P-Cl > 114 mmol/l). Altogether 217 of 445 [48.8% (95% CI 44.2-53.4%)] patients developed AKI. Of these 217, AKI was diagnosed in 62 (28.6%) after 24 h from ICU admission and were included in the analysis regarding development of AKI. ClTWM 24 was associated with an increased risk for the development of AKI (OR1.099; 1.003-1.205) after multivariable adjustments. According to ClTWM 24 , no difference in 90-day mortality between severely hyperchloremic patients and others existed. CONCLUSIONS More than three of four critically ill patients had hyperchloremia and 1 of 10 had its severe form. Higher time-weighted mean chloride was independently associated with an increased risk for AKI.
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Affiliation(s)
- M. Marttinen
- Division of Intensive Care Medicine; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - E. Wilkman
- Division of Intensive Care Medicine; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Division of Anaesthesiology; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - L. Petäjä
- Division of Anaesthesiology; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - R. Suojaranta-Ylinen
- Division of Anaesthesiology; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - V. Pettilä
- Division of Intensive Care Medicine; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. T. Vaara
- Division of Intensive Care Medicine; Department of Anaesthesiology; Intensive Care and Pain Medicine; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Skrifvars M, Vaahersalo J, Reinikainen M, Bendel S, Kurola J, Tiainen M, Raj R, Pettilä V, Varpula T, Group FS. Association between oxygenation and 6-month mortality during post-cardiac arrest care. Crit Care 2013. [PMCID: PMC3642693 DOI: 10.1186/cc12253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kaukonen KM, Linko R, Herwald H, Lindbom L, Ruokonen E, Ala-Kokko T, Pettilä V. Heparin-binding protein (HBP) in critically ill patients with influenza A(H1N1) infection. Clin Microbiol Infect 2013; 19:1122-8. [PMID: 23402373 DOI: 10.1111/1469-0691.12156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 10/30/2012] [Revised: 12/13/2012] [Accepted: 12/24/2012] [Indexed: 11/28/2022]
Abstract
Heparin-binding protein (HBP) is an inducer of vascular endothelial leakage in severe infections. Fluid accumulation into alveoli is a general finding in acute respiratory distress syndrome (ARDS). Severe acute respiratory failure with ARDS is a complication of influenza A(H1N1) infection. Accordingly, we studied the HBP levels in critically ill patients with infection of influenza A(H1N1).Critically ill patients in four intensive care units (ICUs) with polymerase chain reaction (PCR) confirmed infection of influenza A(H1N1) were prospectively evaluated. We collected clinical data and blood samples at ICU admission and on day 2. Twenty-nine patients participated in the study. Compared with normal plasma levels, the HBP concentrations were highly elevated at baseline and at day 2: 98 ng/mL (62-183 ng/mL) and 93 ng/mL (62-271 ng/mL) (p 0.876), respectively. HBP concentrations were correlated with the lowest ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen (PF ratio) during the ICU stay (rho = -0.321, p <0.05). In patients with and without invasive mechanical ventilation, the baseline HBP levels were 152 ng/mL (72-237 ng/mL) and 83 ng/mL (58-108 ng/mL) (p 0.088), respectively. The respective values at day 2 were 223 ng/mL (89-415 ng/mL) and 81 ng/mL (55-97 ng/mL) (p <0.05). The patients with septic shock/severe sepsis (compared with those without) did not have statistically significant differences in HBP concentrations at baseline or day 2. HBP concentrations are markedly elevated in all critically ill patients with influenza A(H1N1) infection. The increase in HBP concentrations seems to be associated with more pronounced respiratory dysfunction.
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Affiliation(s)
- K-M Kaukonen
- Department of Anaesthesiology and Intensive Care Medicine, Division of Surgery, Intensive Care Units, Helsinki University Hospital, Helsinki, Finland; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Wernerman J, Kirketeig T, Andersson B, Berthelson H, Ersson A, Friberg H, Guttormsen AB, Hendrikx S, Pettilä V, Rossi P, Sjöberg F, Winsö O. Scandinavian glutamine trial: a pragmatic multi-centre randomised clinical trial of intensive care unit patients. Acta Anaesthesiol Scand 2011; 55:812-8. [PMID: 21658010 DOI: 10.1111/j.1399-6576.2011.02453.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low plasma glutamine concentration is an independent prognostic factor for an unfavourable outcome in the intensive care unit (ICU). Intravenous (i.v.) supplementation with glutamine is reported to improve outcome. In a multi-centric, double-blinded, controlled, randomised, pragmatic clinical trial of i.v. glutamine supplementation for ICU patients, we investigated outcomes regarding sequential organ failure assessment (SOFA) scores and mortality. The hypothesis was that the change in the SOFA score would be improved by glutamine supplementation. METHODS Patients (n=413) given nutrition by an enteral and/or a parenteral route with the aim of providing full nutrition were included within 72 h after ICU admission. Glutamine was supplemented as i.v. l-alanyl-l-glutamine, 0.283 g glutamine/kg body weight/24 h for the entire ICU stay. Placebo was saline in identical bottles. All included patients were considered as intention-to-treat patients. Patients given supplementation for >3 days were considered as predetermined per protocol (PP) patients. RESULTS There was a lower ICU mortality in the treatment arm as compared with the controls in the PP group, but not at 6 months. For change in the SOFA scores, no differences were seen, 1 (0,3) vs. 2 (0.4), P=0.792, for the glutamine group and the controls, respectively. CONCLUSION In summary, a reduced ICU mortality was observed during i.v. glutamine supplementation in the PP group. The pragmatic design of the study makes the results representative for a broad range of ICU patients.
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Affiliation(s)
- Jan Wernerman
- Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Higgins AM, Pettilä V, Harris AH, Bailey M, Lipman J, Seppelt IM, Webb SA. The critical care costs of the influenza A/H1N1 2009 pandemic in Australia and New Zealand. Anaesth Intensive Care 2011; 39:384-91. [PMID: 21675057 DOI: 10.1177/0310057x1103900308] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to determine the critical care and associated hospital costs for 2009 influenza A/H1N1 patients admitted to intensive care units (ICU) in Australia and New Zealand during the southern hemisphere winter All 762 patients admitted to ICUs in Australian and New Zealand between 1 June and 31 August 2009 with confirmed 2009 H1N1 influenza A were included. Costs were assigned based on ICU and hospital length-of-stay, using data from a single Australian ICU which estimated the daily cost of an ICU bed, along with published costs for a ward bed. Additional costs were assigned for allied health, overheads and extracorporeal membrane oxygenation services. The median (interquartile range) ICU and total hospital costs per patient were AU$35,942 ($10,269 to $82,152) and AU$51,294 ($22,849 to $110,340) respectively, while the mean (standard deviation) ICU and total hospital costs per patient were AU$63,298 ($78,722) and AU$85,395 ($147,457), respectively. A multivariate analysis found death was significantly associated with a reduction in the log of total costs, while the use of mechanical ventilation and ICU admission with viral pneumonitis/acute respiratory distress syndrome or secondary bacterial pneumonia were significantly associated with an increase in the log of total costs. The cost of 2009 H1N1 patients in ICU was significantly higher than the previously published costs for an average ICU admission, and the total cost of treating 2009 H1N1 patients in ICU admitted during winter 2009 was more than $65,000,000.
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Affiliation(s)
- A M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Okkonen M, Varpula M, Linko R, Perttilä J, Varpula T, Pettilä V. N-terminal-pro-BNP in critically ill patients with acute respiratory failure: a prospective cohort study. Acta Anaesthesiol Scand 2011; 55:749-57. [PMID: 21480833 DOI: 10.1111/j.1399-6576.2011.02439.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in unselected critically ill patients with acute respiratory failure (ARF). METHODS Prospective, observational cohort study in 25 intensive care units in Finland. This study included a total of 602 patients with laboratory samples from 958 consecutive patients with ARF treated either with invasive or with non-invasive ventilatory support (the FINNALI study). Plasma NT-pro-BNP samples were drawn after the onset of ventilatory support (day 0) and on the morning of the second day. RESULTS The median [interquartile ranges (IQR)] NT-pro-BNP-values were significantly higher at baseline in 90-day non-survivors than the survivors, 4378 pg/ml (1400-13,943 pg/ml) vs. 1052 pg/ml (232-4076 pg/ml), respectively. The median (IQR) NT-pro-BNP values were significantly higher in patients with chronic cardiac disease or cardiac surgery than in non-cardiac patients, 1947 pg/ml (801-4687 pg/ml) vs. 417 pg/ml (153-1735 pg/ml), respectively, if renal function was normal. With deteriorating renal function, the NT-pro-BNP values showed a significant increase. The area under curve for baseline NT-pro-BNP predicting 90-day mortality was moderate: 0.718 (95% confidence interval 0.674-0.761). Baseline NT-pro-BNP over 1765 pg/ml was independently associated with 90-day mortality by logistic regression analysis (P<0.001). CONCLUSIONS NT-pro-BNP on admission is commonly elevated and independently associated with 90-day mortality in critically ill ARF patients. However, the routine use of NT-pro-BNP for prognostic purpose does not seem to add value to clinical data in ARF patients.
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Affiliation(s)
- M Okkonen
- Department of Anaesthesia and Intensive Care Medicine, Division of Surgery, Helsinki University Central Hospital, Finland
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Linko R, Karlsson S, Pettilä V, Varpula T, Okkonen M, Lund V, Ala-Kokko T, Ruokonen E. Serum zinc in critically ill adult patients with acute respiratory failure. Acta Anaesthesiol Scand 2011; 55:615-21. [PMID: 21827444 DOI: 10.1111/j.1399-6576.2011.02425.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Zinc deficiency leads to susceptibility to infections and may affect pulmonary epithelial cell integrity. Low zinc levels have also been associated with a degree of organ failure and decreased survival in critically ill children. Accordingly, the purpose of the study was to assess serum zinc in adult patients with acute respiratory failure, its association with ventilatory support time, intensive care unit (ICU) length of stay (LOS), organ dysfunction and 30-day mortality. METHODS We included consecutive patients with acute respiratory failure during an eight-week prospective, observational multicentre study (the FINNALI-study). Acute respiratory failure was defined as a need for either non-invasive or invasive positive pressure ventilation for >6 h regardless of the underlying cause or risk factors. After informed consent, a sample for zinc measurement was drawn at 6 h after the start of treatment and analysed from 551 of these patients. RESULTS Low serum zinc was frequent (95.8%) at the onset acute respiratory failure. The median interquartile range [IQR] was 4.7 [3.0-6.9] μmol/l. The median [IQR] serum zinc levels in non-infectious, sepsis and septic shock patients were 5.0 [3.1-7.1], 5.1 [3.5-7.3] and 3.8 [2.6-5.9] μmol/l, respectively, P<0.01. Baseline zinc levels were not associated with ventilatory support time (P=0.98) or ICU LOS (P=0.053). The area under curve in receiver operating characteristics analysis for serum zinc regarding 30-day mortality was 0.55 (95% CI 0.49-0.60). CONCLUSIONS Serum zinc on initiation of ventilation had no predictive value for 30-day mortality, ventilatory support time or intensive care unit LOS.
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Affiliation(s)
- R Linko
- Helsinki University Hospital, Anesthesia and Intensive Care Medicine, Finland.
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20
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Abstract
BACKGROUND Tight glycemic control reduces mortality in surgical intensive care patients and in long-term medical intensive care patients. A large study on intensive insulin therapy was prematurely discontinued due to safety issues. As the safety of intensive insulin therapy has been questioned, we screened all patients during a 17-month period to reveal the incidence of hypoglycemia and its effects on the outcome of the patients. METHODS All patients treated between February 2005 and June 2006 in two intensive care units (ICUs) of a tertiary care teaching hospital were included in the study. A nurse-driven intensive insulin therapy with a target blood glucose level of 4-6 mmol/l had been introduced earlier. The patients were divided into two groups according to the presence of severe hypoglycemia (<or=2.2 mmol/l). RESULTS One thousand two hundred and twenty-four patients (1124 treatment periods) were included. During the study period, 61,203 blood glucose measurements were performed, 2.6% of which were below and 52.6% above the target range. Severe hypoglycemia (glucose <or=2.2 mmol/l) occurred in 25 patients (36 measurements). The incidence was 0.06% of the measurements and 2.3% of the patients. The median age, sex, Acute Physiology And Chronic Health Evaluation II, Simplified Acute Physiology Score II, diagnosis category, ICU or hospital length of stay did not differ between the groups. The hospital mortalities were 25% and 15% in patients with or without severe hypoglycemia, respectively (P=0.16). CONCLUSION Severe hypoglycemia during intensive insulin therapy is rare in clinical practice compared with previous clinical trials.
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Affiliation(s)
- K-M Kaukonen
- Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Varpula M, Karlsson S, Parviainen I, Ruokonen E, Pettilä V. Community-acquired septic shock: early management and outcome in a nationwide study in Finland. Acta Anaesthesiol Scand 2007; 51:1320-6. [PMID: 17944634 DOI: 10.1111/j.1399-6576.2007.01439.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To determine how the early treatment guidelines were adopted, and what was the impact of early treatment on mortality in septic shock in Finland. METHODS This study was a sub-analysis of a prospective observational investigation of severe sepsis and septic shock in Finland (Finnsepsis). All patients with severe sepsis over 4 months in 24 intensive care units were included in the Finnsepsis study. Patients with community-acquired septic shock, admitted directly from the emergency department to the intensive care unit, were included in the sub-study. The following treatment targets were evaluated: measurement of lactate during the first 6 h; analysis of blood culture before antibiotics; commencement of antibiotics within 3 h; attainment of a mean arterial pressure of > or =65 mmHg, central venous pressure of > or =8 mmHg and central venous oxygen saturation of > or =70% or mixed venous oxygen saturation of > or =65% during the first 6 h. RESULTS Of the 92 patients who fulfilled the inclusion criteria, six reached all treatment targets and 33 reached four or more targets (group > or =4). The hospital mortality of group > or =4 was 24% (8/33), compared with 42% (25/59) for those who reached three or fewer targets (group < or =3) (P= 0.08). The 1-year mortality rates of group > or =4 and group < or =3 were 36% and 59% (P= 0.04), respectively. In logistic regression analysis, a delayed initiation of antimicrobials was associated with an unfavourable outcome (P= 0.04). CONCLUSIONS Compliance with international guidelines for the early treatment of septic shock was poor in Finnish hospitals. A failure to diagnose early and to start appropriate treatment was reflected in the high mortality. The delayed start of antibiotics was the most important individual variable leading to a high mortality in this nationwide study.
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Affiliation(s)
- M Varpula
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland.
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Oksanen T, Pettilä V, Hynynen M, Varpula T. Therapeutic hypothermia after cardiac arrest: implementation and outcome in Finnish intensive care units. Acta Anaesthesiol Scand 2007; 51:866-71. [PMID: 17635393 DOI: 10.1111/j.1399-6576.2007.01365.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Therapeutic hypothermia (TH) has been shown to increase survival after out-of-hospital resuscitation. The aim of our study was to find out nationwide implementation and the actual utilization of TH after cardiac arrest in Finnish intensive care units (ICUs). We also determined the outcomes and describe demographic variables of the patients treated with TH. METHODS We analyzed a nationwide prospective database and included all adult patients (1,555) treated in ICUs after cardiac arrest during 2004 and 2005. RESULTS During 2004 and 2005, 407 patients were treated with TH and TH was used in 19 out of the 20 ICUs. The proportion of cardiac arrest patients treated with TH had increased from 4% in 2002 to 28% in 2005. The incidence of cardiac arrest patients admitted to ICUs was 15/100,000 inhabitants/year. The use of TH varied in different areas of the country from 3.4 to 5.0/100,000 inhabitants/year. In-hospital mortality of TH patients was 32.7% and increased from 13.2% in age group <45 years to 46.0% in age group >75 years (P = 0.0002). Six-month survival was 55.3%. Median (interquartile range) length of stay in the ICU was 3.7 (2.7-5.3) days. CONCLUSION In Finland, TH is implemented in almost all ICUs but it is applied only to a selected group of patients. Six months after cardiac arrest, more than half of the patients treated with TH were alive. Among patients treated with TH, younger patients had lower in-hospital mortality.
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Affiliation(s)
- T Oksanen
- Department of Anesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, Finland.
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Peltonen S, Ahlström A, Kylävainio V, Honkanen E, Pettilä V. The effect of combining intermittent hemodiafiltration with forced alkaline diuresis on plasma myoglobin in rhabdomyolysis. Acta Anaesthesiol Scand 2007; 51:553-8. [PMID: 17430315 DOI: 10.1111/j.1399-6576.2007.01289.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to examine the effect of combining intermittent hemodiafiltration (HDF) with forced alkaline diuresis on plasma myoglobin in rhabdomyolysis. METHODS This was a prospective, randomized, controlled, cross-over study. Sixteen rhabdomyolysis patients with plasma myoglobin concentrations above 10,000 microg/l were randomized. Forced alkaline diuresis was started immediately after allocation and continued throughout the study. HDF, which lasted for 4 h, was started in group A immediately after allocation and in group B 4 h later. The primary analysis was intention-to-treat by repeated measures analysis of variance and Mann-Whitney U-test. RESULTS The percentage elimination of myoglobin from the circulation during HDF differed significantly from that during alkaline diuresis (28.1% vs. 14.2%, respectively; P < 0.01). The mean decrease in plasma myoglobin concentration during HDF [9731 microg/l; 95% confidence interval (CI), 3672-5345 microg/l] and forced alkaline diuresis (3646 microg/l; 95% CI, 1260-6032 microg/l) did not show a statistically significant difference (P= NS). The mean total amount of myoglobin found in the ultrafiltrate was 58.4 mg. CONCLUSION The percentage myoglobin decrease during combined HDF and forced alkaline diuresis was higher than that during forced alkaline diuresis alone. Renal replacement therapy with filtration techniques may be considered for the clearance of myoglobin from plasma when urine alkalinization is not successful.
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Affiliation(s)
- S Peltonen
- Division of Nephrology, Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland
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Hynninen M, Wennervirta J, Leppäniemi A, Pettilä V. Organ dysfunction and long term outcome in secondary peritonitis. Langenbecks Arch Surg 2007; 393:81-6. [PMID: 17372753 DOI: 10.1007/s00423-007-0160-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 10/25/2006] [Accepted: 01/24/2007] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Secondary peritonitis is still associated with high mortality, especially when multiorgan dysfunction complicates the disease. Good prognostic tools to predict long term outcome in individual patients are lacking and therefore require further study. PATIENTS AND METHODS 163 consecutive patients with secondary peritonitis were included, except those with postoperative or traumatic peritonitis. In 58 patients treated in the intensive care unit (ICU), organ dysfunction was quantified using Sequential Organ Failure Assessment (SOFA) score in the first 4 days. Predictive factors for poor outcome were evaluated in all patients. Hospital and 1-year mortality was assessed. RESULTS Hospital mortality was 19% and 1-year mortality 23%. Acute physiology and chronic health evaluation II (APACHE II), previous functional status, and sepsis category were predictive of fatal outcome in the total cohort (p = 0.034, p < 0.001, and p < 0.001). In patients treated in the ICU, advanced age and admission SOFA score were independent predictors of death (p = 0.014, p < 0.0001). The SOFA score showed the best discriminative ability for poor outcome (AuROC 0.78). CONCLUSION Degree of organ dysfunction measured using SOFA score was the best predictor of hospital mortality in patients suffering from secondary peritonitis.
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Affiliation(s)
- M Hynninen
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, Haartmaninkatu 4, 00029 HUS Helsinki, Finland.
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Virkkunen I, Ryynänen S, Kujala S, Vuori A, Piilonen A, Kääriä JP, Kähärä V, Pettilä V, Yli-Hankala A, Silfvast T. Incidence of regurgitation and pulmonary aspiration of gastric contents in survivors from out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2007; 51:202-5. [PMID: 17261147 DOI: 10.1111/j.1399-6576.2006.01229.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The regurgitation of gastric contents and subsequent pulmonary aspiration remain serious adverse events in cardiac arrest and cardiopulmonary resuscitation. The aim of this study was to determine the association between clinical signs of regurgitation and radiological findings consistent with aspiration in resuscitated out-of-hospital cardiac arrest (OHCA) patients admitted to hospital. METHODS The incidence of regurgitation was studied in 182 successfully resuscitated OHCA patients. The inclusion criterion was the restoration of spontaneous circulation after OHCA not caused by trauma or drug overdose. RESULTS The incidence of regurgitation was 20%. Regurgitation was associated with radiological findings consistent with aspiration with a high specificity (81%) and a low sensitivity (46%). CONCLUSIONS Although there was a strong association between clinical regurgitation and radiological findings consistent with aspiration, our data suggest that regurgitation is not invariably followed by radiological findings compatible with aspiration. Radiological findings consistent with aspiration are relatively infrequent without preceding signs of regurgitation in resuscitated patients.
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Affiliation(s)
- I Virkkunen
- Department of Surgery and Anaesthesiology, Tampere University Hospital, Tampere, Finland.
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26
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Kaukonen M, Rantala M, Pettilä V, Hynninen M. Severe hypoglycaemia during intensive insulin therapy: a rare event in critically ill patients. Crit Care 2007. [PMCID: PMC4095188 DOI: 10.1186/cc5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Rantala M, Kaukonen K, Pettilä V. Computer management systems and protocols in intensive care units: do we have any benefit? Crit Care 2007. [PMCID: PMC4095485 DOI: 10.1186/cc5592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Saukkonen KA, Varpula M, Räsänen P, Roine RP, Voipio-Pulkki LM, Pettilä V. The effect of emergency department delay on outcome in critically ill medical patients: evaluation using hospital mortality and quality of life at 6 months. J Intern Med 2006; 260:586-91. [PMID: 17116010 DOI: 10.1111/j.1365-2796.2006.01716.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of delay in emergency department (ED) on outcome of critically ill patients admitted to the medical intensive care unit (MICU). Outcome was defined as hospital mortality and as health-related quality of life (HRQoL) at 6 months after intensive care assessed by the 15D measure. The 15D is a generic, 15-dimensional, standardized measure of HRQoL. We hypothesized that prolonged stay in the ED is related to worse outcome. DESIGN AND SETTING A prospective follow-up cohort study in university hospital. SUBJECTS All consecutive 1675 patients admitted to the MICU between July 2002 and June 2004. RESULTS The 15D questionnaire was mailed to all patients alive at 6 months after admission. Of all MICU patients, 64% were admitted from ED. The mean length of stay in the ED was 6.2 h (95%CI 5.9-6.5 h). The hospital mortality rate was 24.4% (20.0% in the ED vs. 33.0% in the non-ED cohort, P < 0.001) and it was associated with higher age and degree of physiological derangement at admission. Neither the length of ED stay was associated with hospital mortality (P = 0.82) nor with HRQoL at 6 months after MICU admission (P = 0.34). Altogether, HRQoL at 6 months was significantly lower compared with the age- and sex-matched general population (P < 0.001). CONCLUSIONS In a university hospital, the length of ED stay was not associated with the outcome of critically ill medical patients. However, we feel that the effect of ED treatment and delay on outcome and outcome prediction in the critically ill patients deserves further evaluation.
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Affiliation(s)
- K A Saukkonen
- Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
BACKGROUND In the intensive care unit (ICU), analgesia and sedation are used to improve the comfort and safety of patients undergoing intensive care therapies. However, continuous administration of sedatives prolongs the time on mechanical ventilation and ICU stay. These adverse effects can be reduced by clear definition of the goals of sedation combined with a sedation protocol. METHODS The adherence to the local sedation guideline of a university affiliated ICU was monitored prospectively before and after intervention: reinforcement of the guideline. The primary endpoints of the study were the occurrence of daily interruption or tapering of sedation and achievement of the target Ramsay scale level (days: 2-3, nights: 3-4) according to the guideline. RESULTS Comparing sedation before and after the intervention (166 and 170 ICU days), no significant differences were observed in the occurrence of daily interruption or tapering of sedatives, 94/129 (73%) vs. 109/139 (78%) of sedation days, nor in the Ramsay scale level during the day, 4 (3-5) vs. 4 (3-5), or in the night, 5 (4-5) vs. 5 (4-5), respectively. After the intervention, Ramsay scale recordings were made more frequently, 280/398 (70%) vs. 234/380 (62%) of the nurses' shifts (P < 0.01). CONCLUSION Adherence to the local sedation guideline was not high, and no significant change was seen after this simple intervention. Continuous education and discussion on the desirable and undesirable effects of sedation, followed by multidisciplinary re-evaluation of the current guideline, are due in our unit.
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Affiliation(s)
- M Tallgren
- Department of Anaesthesia and Intensive Care Medicine, Meilahti Hospital, Helsinki University Hospital, Helsinki, Finland.
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Takala A, Pettilä V, Takkunen O, Rintala E, Kautiainen H, Repo H. Granulocyte colony-stimulating factor therapy and systemic inflammation in critically ill patients. Inflamm Res 2006; 54:180-5. [PMID: 15883741 DOI: 10.1007/s00011-005-1340-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE AND DESIGN The effect of the granulocyte colony-stimulating factor filgrastim on systemic inflammation was investigated in a prospective, randomized, placebo-controlled, double-blind study in critically ill patients. SUBJECTS 59 critically ill patients were recruited within 48 h of intubation due to ventilatory insufficiency. TREATMENT Subcutaneous dosage of placebo or 300 microg filgrastim once daily. METHODS Serum samples were collected at study entry, and 1 and 3 days after the start (Day1 and Day3, respectively). Levels of soluble E-selectin (sE-selectin) and interleukin (IL)-10 were determined by ELISA, and those of IL-6, and soluble IL-2 receptor (sIL-2R) by Immulite chemiluminescence immunoassay. RESULTS The median sE-selectin level decreased by day 3 significantly in the control group but not in the filgrastim group. The difference in the change between the study groups was significant (p = 0.049). IL-10 levels decreased significantly in the filgrastim group, tended to decrease in controls (p = 0.052), and the difference in the change tended to be significant (p = 0.058). IL-6 levels decreased in both groups comparably. sIL-2R levels were elevated and stable. CONCLUSIONS Filgrastim prolongs endothelial activation and possibly inhibits development of immune suppression mediated by IL-10.
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Affiliation(s)
- A Takala
- The Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Virkkunen I, Kujala S, Ryynänen S, Vuori A, Pettilä V, Yli-Hankala A, Silfvast T. Bystander mouth-to-mouth ventilation and regurgitation during cardiopulmonary resuscitation. J Intern Med 2006; 260:39-42. [PMID: 16789977 DOI: 10.1111/j.1365-2796.2006.01664.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether there is an association between bystander mouth-to-mouth ventilation and regurgitation in prehospital cardiac arrest patients. DESIGN Prospectively conducted observational study. SETTING Data were collected from patients treated by the emergency medical service (EMS) systems in three middle-sized or large Finnish urban communities, the Tampere District EMS and the physician-staffed Helicopter EMSs in the Helsinki and Turku areas in southern Finland. SUBJECTS The study population consisted of 529 consecutive prehospital cardiac arrest patients with attempted resuscitation. Exclusion criteria were cardiac arrest due to trauma or drug overdose. MAIN OUTCOME MEASURES Regurgitation in prehospital cardiac arrest patients documented by EMS personnel on the scene. RESULTS Regurgitation occurred in a fourth of patients. Bystander cardiopulmonary resuscitation (CPR) with mouth-to-mouth ventilation was associated with a significantly increased risk of regurgitation compared with no CPR (P < 0.013) and CPR without ventilations (P < 0.01). CONCLUSIONS The mode and role of bystander CPR in cardiac arrest needs to be further evaluated.
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Affiliation(s)
- I Virkkunen
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland.
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Seitsonen E, Hynninen M, Kolho E, Kallio-Kokko H, Pettilä V. Corticosteroids combined with continuous veno-venous hemodiafiltration for treatment of hantavirus pulmonary syndrome caused by Puumala virus infection. Eur J Clin Microbiol Infect Dis 2006; 25:261-6. [PMID: 16550348 PMCID: PMC7101642 DOI: 10.1007/s10096-006-0117-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Reported here are two cases of hantavirus pulmonary syndrome caused by Puumala virus infection, which rapidly resolved after initiation of corticosteroid treatment combined with continuous veno-venous hemodiafiltration. These cases emphasize the role of the inflammatory response in the pathogenesis of hantavirus pulmonary syndrome.
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Affiliation(s)
- E Seitsonen
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Stenbäckinkatu 11, P.O. B 281, 00029 HUS, Helsinki, Finland.
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Laukontaus SJ, Lepäntalo M, Hynninen M, Kantonen I, Pettilä V. Prediction of survival after 48-h of intensive care following open surgical repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2005; 30:509-15. [PMID: 16125419 DOI: 10.1016/j.ejvs.2005.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 04/11/2005] [Accepted: 06/07/2005] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To identify predictive factors for 30-day mortality after 48 h of maximal treatment in intensive care unit (ICU) after repair for ruptured abdominal aortic aneurysm (RAAA). DESIGN Retrospective study in the ICU of the university central hospital. MATERIALS AND METHODS Between 1999 and 2003, a total of 197 patients were admitted to emergency unit due to RAAA, and 185 of them underwent open surgical repair. A total of 138 patients survived at least 48-h and were included in a study to identify factors predictive of 30-day mortality by logistic regression analysis. RESULTS Thirty-day mortality of all RAAA patients was 46% (87/197) whereas the 30-day mortality for those alive at 48 h was 22% (31/138). Forward stepwise multivariate logistic regression analysis revealed that only organ dysfunction by SOFA score (sequential organ failure assessment) at 48-h, preoperative Glasgow Aneurysm Score, and supra-renal clamping in operation were independent predictors of death. CONCLUSIONS Degree of organ dysfunction by SOFA score was the best predictor of 30-day mortality in RAAA patients alive at 48-h after open surgical repair.
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Affiliation(s)
- S J Laukontaus
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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Pettilä V, Ruokonen E. Albumin has no benefit over saline in the critically ill. Acta Anaesthesiol Scand 2005; 49:599-600. [PMID: 15836671 DOI: 10.1111/j.1399-6576.2005.00711.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIMS The serum concentration of cystatin C has recently been proposed as a better indicator of glomerular filtration rate (GFR) than plasma creatinine. Little is known about cystatin C in critical illness. We assessed serum cystatin C as a marker of renal function in acute renal failure (ARF) and its power in predicting survival of ARF patients. MATERIAL 202 consecutive adult patients admitted into the intensive care unit (ICU) during a period of 9 months. METHOD Serum cystatin C, plasma creatinine and plasma urea were measured on admission, daily during the first 3 days, and 5-7 times a week during the rest of the ICU stay. The patients with and without ARF were compared by the Mann-Whitney U-test. The correlation between different variables was calculated by Spearman's correlation. Forward stepwise multiple regression analysis was performed to test independent predictors of mortality. The positive predictive value of serum cystatin C and plasma creatinine for ARF and mortality was calculated by ROC analysis. RESULTS ARF occurred in 54 patients (27%). Serum cystatin C showed excellent positive predictive value for ARF in critical illness by ROC analysis. In acute renal dysfunction, abnormal values of serum cystatin C and plasma creatinine appeared equally quickly (median 3 days). The diagnosis of ARF, the day 1 Apache II score and admission plasma creatinine appeared as independent predictors of hospital mortality. ROC analysis showed only weak predictive power for serum cystatin C and plasma creatinine regarding hospital mortality. CONCLUSIONS Serum cystatin C was as good as plasma creatinine in detecting ARF in intensive care patients. Neither marker was clinically useful in predicting mortality.
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Affiliation(s)
- A Ahlström
- Department of Surgery, Division of Anesthesiology and Intensive Care Medicine, Intensive Care Unit, Helsinki University Hospital, Helsinki, Finland.
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Eklund A, Leppäniemi A, Kemppainen E, Pettilä V. Vasodilatory shock in severe acute pancreatitis without sepsis: is there any place for hydrocortisone treatment? Acta Anaesthesiol Scand 2005; 49:379-84. [PMID: 15752405 DOI: 10.1111/j.1399-6576.2004.00585.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hydrocortisone (HC) has been reported to rapidly improve hemodynamics and reduce the time to vasopressor cessation in septic shock, but none has focused on this effect in acute pancreatitis. We therefore performed a study to assess the effects of hydrocortisone on catecholamine-dependent shock among patients with severe acute pancreatitis. METHODS A retrospective, case-controlled study among 10 patients with severe acute pancreatitis and HC treatment for catecholamine-dependent shock was performed. The control group comprised 11 conventionally treated patients with the same severity of pancreatitis and circulatory shock according to the norepinephrine support required. In focus were the first 48 h from the start of HC administration in the HC group and from the reference point in the control group, respectively. The reference point for the control group was the time point at which doses of norepinephrine exceeded 0.3 microg kg(-1) min(-1). RESULTS Patients in the HC group were weaned off norepinephrine in a significantly shorter time (61 h in HC group vs. 141 h, P = 0.016). The HC group received significantly less norepinephrine (area under curve of norepinephrine dose, P = 0.041). The reduction in norepinephrine dose was comparable at 24 h, being -0.051 (-0.208-0.022) microg kg(-1) min(-1) in the HC group vs. -0.026 (-0.150-0.030) microg kg(-1) min(-1) in the controls (P = 0.307), and at 48 h with respective figures of -0.206 (-0.317 to -0.102) microg kg(-1) min(-1) and -0.103 (-0.178-0.029) microg kg(-1) min(-1) (P = 0.072), from the start of HC administration. CONCLUSION According to our data it seems reasonable to formulate a hypothesis that low doses of HC shorten the time to vasopressor cessation and rapidly reduce the need for norepinephrine support in patients with shock associated with severe acute pancreatitis without sepsis.
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Affiliation(s)
- A Eklund
- Intensive Care Unit, Division of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Dhainaut JF, Yan SB, Joyce DE, Pettilä V, Basson B, Brandt JT, Sundin DP, Levi M. Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost 2004; 2:1924-33. [PMID: 15550023 DOI: 10.1111/j.1538-7836.2004.00955.x] [Citation(s) in RCA: 320] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Disseminated intravascular coagulation (DIC) is a serious condition associated with sepsis. Clinical management of DIC is hampered by lack of clear diagnostic criteria. The International Society on Thrombosis and Haemostasis (ISTH) has proposed a diagnostic scoring algorithm for overt DIC based on routine laboratory tests. The objective was to assess a modified version of the ISTH scoring system and determine the effect of drotrecogin alfa (activated) (DrotAA, recombinant human activated protein C) on patients with DIC. The large database from the PROWESS clinical trial in severe sepsis was retrospectively used to assess a modified ISTH scoring system. Baseline characteristics and treatment effects of DrotAA were evaluated. At baseline, 29% (454/1568) of patients had overt DIC. Overt DIC was a strong predictor of mortality, independent of APACHE II score and age. Placebo-treated patients with overt DIC had higher mortality than patients without (43 vs. 27%). DrotAA-treated patients with overt DIC had a trend towards greater relative risk reduction in mortality than patients without (29 vs. 18%, P = 0.261) but both groups had greater relative risk reduction than placebo-treated patients. Serious bleeding rates during DrotAA infusion in patients with and without overt DIC were slightly increased (P = 0.498), compared with placebo, while clinically overt thrombotic events during the 28-day period were slightly reduced (P = 0.144). Modified ISTH overt DIC scoring may be useful as an independent assessment for identifying severe sepsis patients at high risk of death with a favorable risk/benefit profile for DrotAA treatment. Patients without overt DIC also received significant treatment benefit.
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Affiliation(s)
- J-F Dhainaut
- Service de Réanimation Médicale, Center Hospitalo-Universitaire Cochin Port-Royal, AP-HP, Paris V University, Paris, France
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Ahlström A, Hynninen M, Tallgren M, Kuusela P, Valtonen M, Orko R, Siitonen S, Takkunen O, Pettilä V. Predictive value of interleukins 6, 8 and 10, and low HLA-DR expression in acute renal failure. Clin Nephrol 2004; 61:103-10. [PMID: 14989629 DOI: 10.5414/cnp61103] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10) and their predictive value concerning survival of critically ill systemic inflammatory response syndrome (SIRS) patients with and without acute renal failure (ARF) were evaluated. MATERIAL A total of 103 consecutive adult patients with SIRS from 2 university hospital intensive care units participated in the study. METHOD Laboratory data for all patients were prospectively collected on the day of admission and 2 days thereafter. Patients with acute renal failure (ARF) and non-ARF patients were compared by Mann-Whitney U-test. Independent predictors of mortality were tested using forward stepwise logistic multiple regression analysis. The discriminative power of different variables was tested using receiver operating characteristic (ROC) curve analysis. RESULTS ARF developed in 36 patients (35%). ARF patients showed significantly lower HLA-DR expression and higher plasma levels of IL-6, IL-8 and IL-10 than non-ARF patients. In ARF, moderate discriminative power in predicting survival was observed for day 2 IL-6 and IL-10 plasma levels (AUCs 0.703 and 0.749, respectively). CONCLUSIONS We found no clinically significant discriminative power in predicting survival of ARF patients for monocyte HLA-DR expression or cytokine plasma levels. Therefore, our results do not support the use of HLA-DR expression or cytokine plasma levels for that purpose.
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Affiliation(s)
- A Ahlström
- Department of Surgery, Division of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
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Skrifvars MB, Pettilä V, Rosenberg PH, Castrén M. A multiple logistic regression analysis of in-hospital factors related to survival at six months in patients resuscitated from out-of-hospital ventricular fibrillation. Resuscitation 2003; 59:319-28. [PMID: 14659601 DOI: 10.1016/s0300-9572(03)00238-7] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The impact of the immediate in-hospital post-resuscitation care after out-hospital cardiac arrest is not well known. Based on treatment variables and laboratory findings a multiple logistic regression model was created for the prediction of survival at 6 months from the event. MATERIALS AND METHODS A retrospective study of the hospital charts of patients successfully resuscitated and treated in one of three community hospitals from 1998 to 2000. In addition to several pre-hospital variables, the mean 72 h values of clinical features such as blood pressure, blood glucose concentration and initiated treatment used, were included in a forward multiple logistic regression model predicting survival at 6 months from the event. RESULTS The charts of 98 out of a total of 102 patients were sufficiently complete and included in the analysis. Variables independently associated with survival were age, delay before a return of spontaneous circulation, mean blood glucose and serum potassium, and the use of beta-blocking agents during post-resuscitation care. When those patients who were assigned a 'do not attempt to resuscitate' (DNAR) order during the first 72 h of treatment were excluded from the analysis blood glucose, blood potassium and the use beta-blocking agents remained independently associated with survival. CONCLUSION This study suggests that in-hospital factors are associated with survival from out-of-hospital cardiac arrest. The mean blood glucose and serum potassium during the first 72 h of treatment and the use of beta-blocking agents were significantly and independently associated with survival.
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Affiliation(s)
- M B Skrifvars
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, P.O. Box 340, FIN-00029 HUS Helsinki, Finland.
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Abstract
BACKGROUND Ionized hypocalcemia is common among critically ill patients, and it has been shown to correlate with increased mortality. The purpose of this study was to examine the performance and independence of ionized calcium (Ca2+) in prediction of all-cause day-30 mortality among critically ill adult patients. METHODS Of 993 critically ill patients treated in the Helsinki University Hospital during a 24-month period, the study comprised 941 patients without calcium supplementation. Patient and laboratory data were obtained retrospectively from an intensive care database. The discriminative powers of admission and lowest Ca2+ values regarding day-30 mortality were evaluated by producing receiver operating curves (ROC). Hazard ratios for death of severe and mild hypocalcemia were calculated by Cox regression model. RESULTS The prevalence of ionized hypocalcemia (Ca2+ <1.16 mmol l-1) was 85%. Of 941 patients, 45 (4.7%) had ionized calcium >1.3 mmol l-1 and were excluded from mortality analysis. Univariate Cox regression model revealed hazard ratios of 5.1 (95% confidence interval, CI 2.9-9.0) for severe (<0.90 mmol l-1) and 1.8 (95% CI 1.3-2.4) for mild ionized hypocalcemia (0.90-1.15 mmol l-1) on admission, but hypocalcemia was not shown to be independently associated with mortality by multivariate Cox regression model. In prediction of day-30 mortality admission and lowest Ca2+, levels had areas under curves of 0.636 and 0.671, respectively. CONCLUSION Ionized hypocalcemia is common among critically ill adults and it is associated with increased mortality. Although non-survivors and survivors differ significantly in admission Ca2+, hypocalcemia is not independently associated with day-30 mortality.
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Affiliation(s)
- J Hästbacka
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
BACKGROUND In critically ill patients optimal transfusion therapy for most clinical settings has not been determined. The objective of this study was to evaluate the impact of a computerized audit on transfusion decisions of red blood cells (RBC), fresh frozen plasma (FFP), and platelets among critically ill patients. METHODS Two hundred and ninety consecutive patients admitted to nine-bed medical-surgical intensive care unit at a university hospital were included in this prospective study. Prior to the study, the criteria for transfusions of RBCs, FFP and platelets were established. Phase I, the first 3-month period served as a control period. During phase II the fulfilment of these criteria was prospectively monitored by an audit software belonging to the computerized blood request program. If the predefined transfusion criteria were not met the audit software was automatically activated. The last 3-month period, phase III, was to assess if possible effects on transfusion decisions were permanent. RESULTS The proportion of RBC transfusions administered according to predefined trigger during the study phases I, II, and III were 55.9%, 75.1% and 67.9%, respectively (P < 0.001). The proportion of FFP and platelet transfusions according to a predefined trigger did not differ statistically significantly between the study phases. Logistic multiple regression analysis revealed an independent effect of the audit phase on the decision to transfuse RBCs and FFP. CONCLUSIONS The data suggests that a computerized prospective transfusion audit has impact on the realisation of predefined transfusion decisions.
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Affiliation(s)
- J Pentti
- Department of Anaesthesiology and Intensive Care Medicine, Central Hospital of Kymenlaakso, Kotka, Finland.
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Varpula T, Jousela I, Niemi R, Takkunen O, Pettilä V. Combined effects of prone positioning and airway pressure release ventilation on gas exchange in patients with acute lung injury. Acta Anaesthesiol Scand 2003; 47:516-24. [PMID: 12699507 DOI: 10.1034/j.1399-6576.2003.00109.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Prone positioning has been shown to improve oxygenation in 60-70% of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Another way to improve matching of ventilation to perfusion is the use of partial ventilatory support. Preserving spontaneous breathing during mechanical ventilation has been shown to improve oxygenation in comparison with controlled mechanical ventilation. However, no randomized studies are available exploring the effects of preserved spontaneous breathing on gas exchange in combination with prone positioning. Our aim was to determine whether the response of oxygenation to the prone position differs between pressure-controlled synchronized intermittent mandatory ventilation with pressure support (SIMV-PC/PS) and airway pressure release ventilation with unsupported spontaneous breathing (APRV). METHODS We undertook a prospective randomized intervention study in a medical-surgical adult intensive care unit of a university hospital. Of 45, 33 ALI patients (acute lung injury) within 72 h after initiation of mechanical ventilation, and in whom the prone position was applied according to a predefined strategy, were included in the study. After initial stabilization the patients were randomized to receive either SIMV-PC/PS or APRV with predefined general ventilatory goals (PEEP, tidal volume, inspiratory pressure and PaCO2-level). The protocol for prone positioning was the same for both treatment arms. Prone positioning was triggered by finding a PaO2/FiO2-ratio below 200 mmHg evaluated twice per day. The duration of each prone episode was 6 h. RESULTS The first two episodes of prone positioning were analyzed. Gas exchange was measured before and at the end of prone positioning. Of the 45 patients enrolled, 33 were turned prone once and 28 twice. No significant differences were detected in baseline characteristics. Changes in oxygenation were analyzed in response to the first and second prone episodes 5 h and 24 h after randomization and initiation of SIMV-PC/PS or APRV respectively. Before the first prone episode the PaO2/FiO2-ratio was significantly better (P = 0.02) in the APRV-group (median; interquartile range) (162; 108-192 mmHg) than in the SIMV-PC/PS-group (123; 78-154 mmHg). The response in oxygenation to the first prone episode was similar in both groups: PaO2/FiO2-ratio increased 39.5; 17.75-77.5 mmHg in the SIMV-PC/PS-group and 75.0; 9.0-125.0 mmHg in the APRV-group (P = 0.49). Before the second prone episode, the PaO2/FiO2-ratio was comparable (SIMV-PC/PS 130.5; 61.0-161.0 mmHg vs. APRV 134; 98.3-175.0 mmHg). Improvement in oxygenation was significantly (P = 0.02) greater in the APRV group (82; 37.0-141.0 mmHg) than in the SIMV-PC/PS group (50; 24.0-68.8 mmHg) during the second prone episode. General ventilatory and hemodynamic variables and use of sedatives were similar in both groups during the study. CONCLUSIONS APRV during prone positioning is feasible in the treatment of ALI patients. APRV after 24 h appears to enhance improvement in oxygenation in response to prone positioning.
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Affiliation(s)
- T Varpula
- Intensive Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
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Korhonen SJ, Kantonen I, Pettilä V, Keränen J, Salo JA, Lepäntalo M. Long-term survival and health-related quality of life of patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2003; 25:350-3. [PMID: 12651174 DOI: 10.1053/ejvs.2002.1880] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION the outcome of ruptured abdominal aortic aneurysm (RAAA) patients is most frequently measured as operative or in-hospital mortality rate. However, survival alone is not an indicator of quality of the treatment. Assessment of quality of life (QoL) is used increasingly and is a relevant measure of outcome. OBJECTIVE to assess long-term survival and QoL of patients undergoing repair of RAAA. DESIGN follow-up study with cross-sectional QoL evaluation. MATERIALS AND METHODS between 1996 and 2000, 199 of 220 patients with RAAA underwent surgery. Survivors were sent the generic the RAND 36-item Health Survey (RAND-36) self-administered questionnaire. RESULTS total hospital mortality and operative mortality were 103 of 220 (47%) and 82 of 199 (41%). Of the 117 initial survivors, 21 were deceased at the time of the study. When compared to an age- and sex-adjusted general population, only physical functioning was significantly impaired (p=0.01) in the 82 of 93 (88%) RAAA survivors who responded. CONCLUSIONS survivors after repair of RAAA had almost the same QoL as the norms of an age- and sex-adjusted general population, justifies an aggressive operative policy in RAAA.
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Affiliation(s)
- S J Korhonen
- Department of Vascular Surgery, Helsinki University Central Hospital, HUCH, Finland
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Abstract
BACKGROUND The number of failing organs systems in ICU patients with haematological malignancy is associated with outcome. The objective of this study was to assess short and long-term survival in these patients with special reference to multiple organ failure reflected by the SOFA (Sequential Organ Failure Assessment) score. METHODS Retrospective chart review of haematological patients admitted to the 10-bed intensive care unit (ICU) of a tertiary level academic teaching hospital from 1994 to 1998. Of 31 admitted patients with the diagnosis of haematological malignancy, the charts of 30 were available for analysis. RESULTS Univariate logistic regression analysis of factors previously shown to influence survival revealed that only admission SOFA score and untreated status of haematological disease were significantly associated with survival (P < 0.05). ICU, 3-month and one-year survival rates were 57% (17/30), 23% (7/30) and 20% (6/30), respectively. If maximal SOFA score during the ICU stay was included in a multivariate model comprising treatment status and effect, admission day SOFA and APACHE II scores, mechanical ventilation, renal replacement therapy and neutropenia, the maximal SOFA score became the only independent variable. All patients with an admission SOFA score exceeding 11 died in hospital. Leave-one-out method revealed that admission SOFA scores and the status of haematological disease (untreated or not) correctly classified 83% (25 of 30) of patients to survivors or non-survivors. CONCLUSIONS Multiple organ failure assessed as SOFA score on admission and status of disease were associated with outcome in critically ill patients with haematological malignancy.
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Affiliation(s)
- T Silfvast
- Department of Anaesthesia and Intensive Care Medicine, Meilahti Hospital, Helsinki, Finland.
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Abstract
BACKGROUND The incidence of withholding and withdrawing life support from the critically ill has increased in recent years. The aim of this study was to assess the degree of consistency between the weight assigned by intensivists to different determinants and their relation to end-of-life decisions, and to evaluate the current concepts in withholding or withdrawing intensive care in Nordic countries. METHODS Forty-one intensivists from Nordic countries completed a questionnaire sent by e-mail: consistency between contributing factors and the decisions regarding 10 actual cases was evaluated by logistic regression analysis and by the classification (leave-one-out) method. Concepts in management after the withdrawal decision were also analyzed. RESULTS The median (range) number of withdrawals per physician was four (range 0-10) out of 10 cases. No single factor was an independent covariant of all decisions made. The classification method revealed that approximately 70% only of decisions could be predicted correctly. Different actions taken after a decision to withdraw intensive care varied from 9.8% (discontinuing ventilator therapy) to 97.6% (informing relatives). CONCLUSIONS No generally accepted grounds for end-of-life decisions could be detected among Nordic intensivists. In addition, the current concept of management after decision to withdraw therapy varies markedly. This study has implications in further assessment of the individual decision-making process and the uniformity of actions after withdrawal decisions.
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Affiliation(s)
- V Pettilä
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Finland.
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Abstract
We present a case of extremely severe postpartum HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, associated with activation of coagulation, massive recurrent intra-abdominal bleeding requiring two laparotomies, renal failure, and central nervous system symptoms. This case underlines the complexity of pregnancy-related thrombotic microangiopathies regarding their differential diagnosis, multiple organ dysfunction, as well as management. Systemic endothelial cell injury plays a central role in the pathogenesis of thrombotic microangiopathies. Treatment of HELLP syndrome usually consists of administration of antihypertensive therapy and magnesium sulfate. No consensus exists regarding the use of plasma exchange or corticosteroids. Plasma exchange was a major part of the treatment regime in our patient. Early plasma exchange may be considered as an adjuvant therapy in severe and progressive postpartum HELLP syndrome.
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Affiliation(s)
- J G Förster
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland.
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Hiekkanen T, Skogberg K, Pettilä V. Evolution of plasma proinflammatory cytokines in malaria-related ARDS treated with corticosteroids. Intensive Care Med 2001; 27:1823-4. [PMID: 11810129 DOI: 10.1007/s00134-001-1116-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2001] [Accepted: 09/03/2001] [Indexed: 11/29/2022]
Affiliation(s)
- T Hiekkanen
- Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland,
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Pettilä V. Predicting risk of death from cardiovascular disease. Outcome prediction is hampered by methodological problems. BMJ 2001; 323:1000. [PMID: 11700623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Pettilä V, Tiula E. Intermittent hemodiafiltration in acute renal failure in critically ill patients. Clin Nephrol 2001; 56:324-31. [PMID: 11680663] [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: 02/22/2023] Open
Abstract
AIMS The objective was to study the effects of daily intermittent on-line predilution hemodiafiltration (IHDF) on laboratory parameters, and on multiple organ dysfunction score (MODS), compared with intermittent hemodialysis (IHD). MATERIAL DESIGN Prospective, randomized, non-blinded study. SETTING A 10-bed medical-surgical intensive care unit in a tertiary-care hospital, 39 patients with acute renal failure. METHODS IHDF or IHD was performed daily with the same equipment: AK 100 Ultra, and Polyflux 17 hemodiafilter up to day 30. Laboratory parameters, MODS, survived days free of acute renal failure treatment, number and complications of treatments, and hospital mortality were recorded. RESULTS Effects of treatments were equal as to urea reduction ratio and changes in serum creatinine, calcium, phosphate and bicarbonate. Survived days free of acute renal failure treatment were fewer for the IHDF (4.8 vs. 10.3 days for the IHD, p = 0.036, Mann-Whitney test). The overall hospital mortality of all patients was 34% (95% CI 18-50%). CONCLUSIONS This study demonstrated equal control of azotemia, acidosis, and calcium-phosphate balance in both treatment groups with no treatment-specific complications of IHDF.
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Affiliation(s)
- V Pettilä
- Department of Surgery, and Helsinki University Central Hospital, Espoo, Finland.
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