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Holm A, Reinikainen M, Kurola J, Vaahersalo J, Tiainen M, Varpula T, Hästbacka J, Lääperi M, Skrifvars MB. Factors associated with fever after cardiac arrest: A post-hoc analysis of the FINNRESUSCI study. Acta Anaesthesiol Scand 2024; 68:635-644. [PMID: 38351520 DOI: 10.1111/aas.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 10/29/2023] [Accepted: 01/28/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Fever after cardiac arrest may impact outcome. We aimed to assess the incidence of fever in post-cardiac arrest patients, factors predicting fever and its association with functional outcome in patients treated without targeted temperature management (TTM). METHODS The FINNRESUSCI observational cohort study in 2010-2011 included intensive care unit (ICU)-treated out-of-hospital cardiac arrest (OHCA) patients from all five Finnish university hospitals and 14 of 15 central hospitals. This post hoc analysis included those FINNRESUSCI study patients who were not treated with TH. We defined fever as at least one temperature measurement of ≥37.8°C within 72 h of ICU admission. The primary outcome was favourable functional outcome at 12 months, defined as cerebral performance category (CPC) of 1 or 2. Binary logistic regression models including witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial rhythm and delay of return of spontaneous circulation were used to compare the functional outcomes of the groups. RESULTS There were 67,428 temperature measurements from 192 patients, of whom 89 (46%) experienced fever. Twelve-month CPC was missing in 7 patients, and 51 (28%) patients had favourable functional outcome at 12 months. The patients with shockable initial rhythms had a lower incidence of fever within 72 h of ICU admission (28% vs. 72%, p < .01), and the patients who experienced fever had a longer median return of spontaneous circulation (ROSC) delay (20 [IQR 10-30] vs. 14 [IQR 9-22] min, p < .01). Only initial non-shockable rhythm (OR 2.99, 95% CI 1.51-5.94) was associated with increased risk of fever within the first 72 h of ICU admission. Neither time in minutes nor area (minutes × degree celsius over threshold) over 37°C, 37.5°C, 38°C, 38.5°C, 39°C, 39.5°C or 40°C were significantly different in those with favourable functional outcome compared to those with unfavourable functional outcome within the first 24, 48 or 72 h from ICU admission. Fever was not associated with favourable functional outcome at 12 months (OR 0.90, 95% CI 0.44-1.84). CONCLUSIONS Half of OHCA patients not treated with TTM developed fever. We found no association between fever and outcome.
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Affiliation(s)
- Aki Holm
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Jouni Kurola
- University of Eastern Finland and Centre of Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Vaahersalo
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tero Varpula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mitja Lääperi
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Pietiläinen L, Hästbacka J, Bendel S, Bäcklund M, Reinikainen M. Physicians' perceptions of intensive care patients' 1-year prognoses compared to realistic prognoses. Acta Anaesthesiol Scand 2024; 68:655-663. [PMID: 38438302 DOI: 10.1111/aas.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/21/2024] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND It is unknown whether physicians treating critically ill patients have realistic perceptions of their patients' prognoses. METHODS We sent a survey by email to Finnish anesthesiologists to investigate their ability to estimate the probability of 1-year survival of intensive care unit (ICU) patients based on data available at the beginning of intensive care. We presented 12 fictional but real-life-based patient cases and asked the respondent to estimate the probability of 1-year survival in each case by choosing one of the alternatives 5%, 10%-90% in 10% intervals and 95%. We compared the physicians' estimates to registry data-based realistic prognoses of comparable patients treated in the ICU. Based on the difference between the estimate and the realistic prognosis, we categorized the estimates into three groups: (1) difference less than 10 percentage points, (2) difference between 10 and 20 percentage points, and (3) difference over 20 percentage points. RESULTS We received 210 responses (totally 2520 estimates). Of the respondents, 43 (20.5%) were specialists working mainly in the ICU, 81 (38.6%) were specialists working occasionally in the ICU, 47 (22.4%) were specialists not working in the ICU, and 39 (18.6%) were doctors in training. The difference between the estimate and the realistic prognosis was less than 10 percentage points for 1083 (43.0%) estimates, between 10 and 20 percentage points for 645 (25.6%) estimates, and over 20 percentage points for 792 (31.4%) estimates, out of which 612 (24.3% of all estimates) underestimated and 180 (7.1%) overestimated the likelihood of survival. The median error (the median of the differences between the estimate and the realistic prognosis) for all estimates was -8.8 [interquartile range (IQR), -20.0 to -0.2], which means that the most typical response underestimated the likelihood of survival by 9 percentage points. Based on the 12 estimates, we calculated the median error for each respondent. The median (IQR) of these median errors was -8.6 (-12.6 to -5.0) for specialists working mainly in the ICU, -8.1 (-13.0 to -5.2) for specialists working occasionally in the ICU, -9.7 (-17.7 to -6.3) for specialists not working in the ICU, and -9.1 (-14.5 to -5.1) for doctors in training (p = .29). CONCLUSION Finnish anesthesiologists commonly misestimate the long-term prognoses of ICU patients, more often underestimating than overestimating the likelihood of 1-year survival. More education about critically ill patients' prognoses and better prediction tools are needed.
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Affiliation(s)
- Laura Pietiläinen
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Hästbacka
- Department of Anesthesia and Intensive Care, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Stepani Bendel
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Minna Bäcklund
- Division of Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
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Moser A, Raj R, Reinikainen M, Jakob SM, Takala J. Effect of mortality prediction models on resource use benchmarking of intensive care units. J Crit Care 2024; 82:154814. [PMID: 38643569 DOI: 10.1016/j.jcrc.2024.154814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Intensive care requires extensive resources. The ICUs' resource use can be compared using standardized resource use ratios (SRURs). We assessed the effect of mortality prediction models on the SRURs. MATERIALS AND METHODS We compared SRURs using different mortality prediction models: the recent Finnish Intensive Care Consortium (FICC) model and the SAPS-II model (n = 68,914 admissions). We allocated the resources to severity of illness strata using deciles of predicted mortality. In each risk and year stratum, we calculated the expected resource use per survivor from our modelling approaches using length of ICU stay and Therapeutic Intervention Scoring System (TISS) points. RESULTS Resource use per survivor increased from one length of stay (LOS) day and around 50 TISS points in the first decile to 10 LOS-days and 450 TISS in the tenth decile for both risk scoring systems. The FICC model predicted mortality risk accurately whereas the SAPS-II grossly overestimated the risk of death. Despite this, SRURs were practically identical and consistent. CONCLUSIONS SRURs provide a robust tool for benchmarking resource use within and between ICUs. SRURs can be used for benchmarking even if recently calibrated risk scores for the specific population are not available.
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Affiliation(s)
- André Moser
- CTU Bern, Department of Clinical Research, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Stephan M Jakob
- University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland
| | - Jukka Takala
- University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland
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Pölkki A, Moser A, Raj R, Takala J, Bendel S, Jakob SM, Reinikainen M. The authors reply. Crit Care Med 2024; 52:e217-e218. [PMID: 38483239 DOI: 10.1097/ccm.0000000000006205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Affiliation(s)
- Anssi Pölkki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - André Moser
- CTU Bern, University of Bern, Bern, Switzerland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Takala
- Department of Intensive Care Medicine, University of Bern, Bern, Switzerland
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University of Bern, Bern, Switzerland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Pölkki A, Moser A, Raj R, Takala J, Bendel S, Jakob SM, Reinikainen M. The Influence of Potential Organ Donors on Standardized Mortality Ratios and ICU Benchmarking. Crit Care Med 2024; 52:387-395. [PMID: 37947476 PMCID: PMC10876165 DOI: 10.1097/ccm.0000000000006098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The standardized mortality ratio (SMR) is a common metric to benchmark ICUs. However, SMR may be artificially distorted by the admission of potential organ donors (POD), who have nearly 100% mortality, although risk prediction models may not identify them as high-risk patients. We aimed to evaluate the impact of PODs on SMR. DESIGN Retrospective registry-based multicenter study. SETTING Twenty ICUs in Finland, Estonia, and Switzerland in 2015-2017. PATIENTS Sixty thousand forty-seven ICU patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We used a previously validated mortality risk model to calculate the SMRs. We investigated the impact of PODs on the overall SMR, individual ICU SMR and ICU benchmarking. Of the 60,047 patients admitted to the ICUs, 514 (0.9%) were PODs, and 477 (93%) of them died. POD deaths accounted for 7% of the total 6738 in-hospital deaths. POD admission rates varied from 0.5 to 18.3 per 1000 admissions across ICUs. The risk prediction model predicted a 39% in-hospital mortality for PODs, but the observed mortality was 93%. The ratio of the SMR of the cohort without PODs to the SMR of the cohort with PODs was 0.96 (95% CI, 0.93-0.99). Benchmarking results changed in 70% of ICUs after excluding PODs. CONCLUSIONS Despite their relatively small overall number, PODs make up a large proportion of ICU patients who die. PODs cause bias in SMRs and in ICU benchmarking. We suggest excluding PODs when benchmarking ICUs with SMR.
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Affiliation(s)
- Anssi Pölkki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - André Moser
- CTU Bern, University of Bern, Bern, Switzerland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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Pietiläinen L, Hästbacka J, Bäcklund M, Selander T, Reinikainen M. A novel score for predicting 1-year mortality of intensive care patients. Acta Anaesthesiol Scand 2024; 68:195-205. [PMID: 37771172 DOI: 10.1111/aas.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND We aimed to develop a simple scoring table for predicting probability of death within 1-year after admission to an intensive care unit. We analysed data on emergency admissions from the nationwide Finnish intensive care quality registry. METHODS We included first admissions of adult patients with data available on 1-year vital status (dead or alive) and all five variables included in a premorbid functional status score, which is the number of activities the person can manage independently of the following five: get out of bed, move indoors, dress, climb stairs and walk 400 m. We analysed data on patient characteristics and admission-associated factors from 2012 to 2014 to find predictors of 1-year mortality and to develop a score for predicting probability of death. We tested the performance of this score in data from 2015. We assessed the 1-year functional status score of survivors with data available. RESULTS Out of 25,261 patients, 20,628 (81.7%) patients were able to perform all five functional activities independently prior to the intensive care unit admission. At 1-year post admission, 19,625 (77.7%) patients were alive. 1-year functional status score was known for 11,011 patients and 8970 (81.5%) patients achieved functional status score 5, managing all five activities independently. The score based on age, sex, preceding functional status, type of intensive care unit admission, severity of acute illness and the most significant diagnoses predicted 1-year mortality with an area under the receiver operating characteristic curve 0.78 (95% CI, 0.76-0.79). The calibration of our prediction model was good, with calibration intercept -0.01 (-0.07 to 0.05) and calibration slope 0.96 (0.90 to 1.02). CONCLUSION Our score based on data available at intensive care unit admission predicted 1-year mortality with fairly good discrimination. Most survivors achieved good functional recovery.
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Affiliation(s)
- Laura Pietiläinen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Johanna Hästbacka
- Department of Anesthesia and Intensive Care, Tampere University Hospital, and Tampere University, Tampere, Finland
| | - Minna Bäcklund
- Division of Intensive Care Medicine, Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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Raj R, Moser A, Starkopf J, Reinikainen M, Varpula T, Jakob SM, Takala J. Variation in Severity-Adjusted Resource use and Outcome for Neurosurgical Emergencies in the Intensive Care Unit. Neurocrit Care 2024; 40:251-261. [PMID: 37100975 PMCID: PMC10861740 DOI: 10.1007/s12028-023-01723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The correlation between the standardized resource use ratio (SRUR) and standardized hospital mortality ratio (SMR) for neurosurgical emergencies is not known. We studied SRUR and SMR and the factors affecting these in patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). METHODS We extracted data of patients treated in six university hospitals in three countries (2015-2017). Resource use was measured as SRUR based on purchasing power parity-adjusted direct costs and either intensive care unit (ICU) length of stay (costSRURlength of stay) or daily Therapeutic Intervention Scoring System scores (costSRURTherapeutic Intervention Scoring System). Five a priori defined variables reflecting differences in structure and organization between the ICUs were used as explanatory variables in bivariable models, separately for the included neurosurgical diseases. RESULTS Out of 28,363 emergency patients treated in six ICUs, 6,162 patients (22%) were admitted with a neurosurgical emergency (41% nontraumatic ICH, 23% SAH, 13% multitrauma TBI, and 23% isolated TBI). The mean costs for neurosurgical admissions were higher than for nonneurosurgical admissions, and the neurosurgical admissions corresponded to 23.6-26.0% of all direct costs related to ICU emergency admissions. A higher physician-to-bed ratio was associated with lower SMRs in the nonneurosurgical admissions but not in the neurosurgical admissions. In patients with nontraumatic ICH, lower costSRURs were associated with higher SMRs. In the bivariable models, independent organization of an ICU was associated with lower costSRURs in patients with nontraumatic ICH and isolated/multitrauma TBI but with higher SMRs in patients with nontraumatic ICH. A higher physician-to-bed ratio was associated with higher costSRURs for patients with SAH. Larger units had higher SMRs for patients with nontraumatic ICH and isolated TBI. None of the ICU-related factors were associated with costSRURs in nonneurosurgical emergency admissions. CONCLUSIONS Neurosurgical emergencies constitute a major proportion of all emergency ICU admissions. A lower SRUR was associated with higher SMR in patients with nontraumatic ICH but not for the other diagnoses. Different organizational and structural factors seemed to affect resource use for the neurosurgical patients compared with nonneurosurgical patients. This emphasizes the importance of case-mix adjustment when benchmarking resource use and outcomes.
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Affiliation(s)
- Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - André Moser
- CTU Bern, University of Bern, Bern, Switzerland
| | - Joel Starkopf
- Anaesthesiology and Intensive Care Clinic, University of Tartu and Tartu University Hospital, Tartu, Estonia
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tero Varpula
- Division of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jukka Takala
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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McLarty J, Litton E, Beane A, Aryal D, Bailey M, Bendel S, Burghi G, Christensen S, Christiansen CF, Dongelmans DA, Fernandez AL, Ghose A, Hall R, Haniffa R, Hashmi M, Hashimoto S, Ichihara N, Kumar Tirupakuzhi Vijayaraghavan B, Lone NI, Arias López MDP, Mat Nor MB, Okamoto H, Priyadarshani D, Reinikainen M, Soares M, Pilcher D, Salluh J. Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study. Thorax 2024; 79:120-127. [PMID: 37225417 DOI: 10.1136/thorax-2022-219592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. METHODS We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry. FINDINGS Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes. INTERPRETATION Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
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Affiliation(s)
- Joshua McLarty
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edward Litton
- St John of God Hospital Subiaco, Perth, Western Australia, Australia
- The University of Western Australia School of Medicine and Pharmacology, Perth, Western Australia, Australia
| | - Abigail Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation (NICRF), Kathmandu, Nepal
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | | | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
| | | | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Ariel L Fernandez
- SATI-Q program, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Aniruddha Ghose
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Ros Hall
- Public Health Scotland, Edinburgh, UK
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | | | - Satoru Hashimoto
- Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Japanese Intensive Care PAtient Database (JIPAD), Tokyo, Japan
| | | | | | - Nazir I Lone
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Maria Del Pilar Arias López
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
- PICU, Hospital de Ninos R Gutierres, Buenos Aires, Argentina
| | - Mohamed Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - David Pilcher
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Jorge Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Vehviläinen J, Virta JJ, Skrifvars MB, Reinikainen M, Bendel S, Ala-Kokko T, Hoppu S, Laitio R, Siironen J, Raj R. Effect of antiplatelet and anticoagulant medication use on injury severity and mortality in patients with traumatic brain injury treated in the intensive care unit. Acta Neurochir (Wien) 2023; 165:4003-4012. [PMID: 37910309 PMCID: PMC10739466 DOI: 10.1007/s00701-023-05850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Antiplatelet and anticoagulant medication are increasingly common and can increase the risks of morbidity and mortality in traumatic brain injury (TBI) patients. Our study aimed to quantify the association of antiplatelet or anticoagulant use in intensive care unit (ICU)-treated TBI patients with 1-year mortality and head CT findings. METHOD We conducted a retrospective, multicenter observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted to four university hospital ICUs during 2003-2013. The patients were followed up until the end of 2016. The national drug reimbursement database provided information on prescribed medication for our study. We used multivariable logistic regression models to assess the association between TBI severity, prescribed antiplatelet and anticoagulant medication, and their association with 1-year mortality. RESULTS Of 3031 patients, 128 (4%) had antiplatelet and 342 (11%) anticoagulant medication before their TBI. Clopidogrel (2%) and warfarin (9%) were the most common antiplatelets and anticoagulants. Three patients had direct oral anticoagulant (DOAC) medication. The median age was higher among antiplatelet/anticoagulant users than in non-users (70 years vs. 52 years, p < 0.001), and their head CT findings were more severe (median Helsinki CT score 3 vs. 2, p < 0.05). In multivariable analysis, antiplatelets (OR 1.62, 95% CI 1.02-2.58) and anticoagulants (OR 1.43, 95% CI 1.06-1.94) were independently associated with higher odds of 1-year mortality. In a sensitivity analysis including only patients over 70, antiplatelets (OR 2.28, 95% CI 1.16-4.22) and anticoagulants (1.50, 95% CI 0.97-2.32) were associated with an increased risk of 1-year mortality. CONCLUSIONS Both antiplatelet and anticoagulant use before TBI were risk factors in our study for 1-year mortality. Antiplatelet and anticoagulation medication users had a higher radiological intracranial injury burden than non-users defined by the Helsinki CT score. Further investigation on the effect of DOACs on mortality should be done in ICU-treated TBI patients.
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Affiliation(s)
- Juho Vehviläinen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL320, 00029 HUS, Helsinki, Finland.
| | - Jyri J Virta
- Perioperative and Intensive Care, Division of Intensive Care, Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tero Ala-Kokko
- Department of Intensive Care, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sanna Hoppu
- Department of Intensive Care and Emergency Medicine Services, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Ruut Laitio
- Department of Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
| | - Jari Siironen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL320, 00029 HUS, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL320, 00029 HUS, Helsinki, Finland
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Lascarrou JB, Ermel C, Cariou A, Laitio T, Kirkegaard H, Søreide E, Grejs AM, Reinikainen M, Colin G, Taccone FS, Le Gouge A, Skrifvars MB. Dysnatremia at ICU admission and functional outcome of cardiac arrest: insights from four randomised controlled trials. Crit Care 2023; 27:472. [PMID: 38041177 PMCID: PMC10693108 DOI: 10.1186/s13054-023-04715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE To evaluate the potential association between early dysnatremia and 6-month functional outcome after cardiac arrest. METHODS We pooled data from four randomised clinical trials in post-cardiac-arrest patients admitted to the ICU with coma after stable return of spontaneous circulation (ROSC). Admission natremia was categorised as normal (135-145 mmol/L), low, or high. We analysed associations between natremia category and Cerebral Performance Category (CPC) 1 or 2 at 6 months, with and without adjustment on the modified Cardiac Arrest Hospital Prognosis Score (mCAHP). RESULTS We included 1163 patients (581 from HYPERION, 352 from TTH48, 120 from COMACARE, and 110 from Xe-HYPOTHECA) with a mean age of 63 ± 13 years and a predominance of males (72.5%). A cardiac cause was identified in 63.6% of cases. Median time from collapse to ROSC was 20 [15-29] minutes. Overall, mean natremia on ICU admission was 137.5 ± 4.7 mmol/L; 211 (18.6%) and 31 (2.7%) patients had hyponatremia and hypernatremia, respectively. By univariate analysis, CPC 1 or 2 at 6 months was significantly less common in the group with hyponatremia (50/211 [24%] vs. 363/893 [41%]; P = 0.001); the mCAHP-adjusted odds ratio was 0.45 (95%CI 0.26-0.79, p = 0.005). The number of patients with hypernatremia was too small for a meaningful multivariable analysis. CONCLUSIONS Early hyponatremia was common in patients with ROSC after cardiac arrest and was associated with a poorer 6-month functional outcome. The mechanisms underlying this association remain to be elucidated in order to determine whether interventions targeting hyponatremia are worth investigating. Registration ClinicalTrial.gov, NCT01994772, November 2013, 21.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, 44000, Nantes, France.
- Médecine Intensive Reanimation, University Hospital Centre, Nantes, France.
- AfterROSC Network, Nantes, France.
- Service de Médecine Intensive Reanimation, CHU Nantes, 30 Boulevard Jean Monet, 44093, Nantes Cedex 9, France.
| | - Cyrielle Ermel
- Médecine Intensive Reanimation, University Hospital Centre, Nantes, France
| | - Alain Cariou
- AfterROSC Network, Nantes, France
- Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, Paris, France
- Médecine Intensive Reanimation, AP-HP, CHU Cochin, Paris, France
| | - Timo Laitio
- Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, University of Turku, Turku, Finland
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine and Anaesthesiology and Intensive Care, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eldar Søreide
- Intensive Care Unit, Department of Anaesthesiology, Stavanger University Hospital and Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Anders M Grejs
- Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Gwenhael Colin
- AfterROSC Network, Nantes, France
- Médecine Intensive Reanimation, CHD Vendee, La Roche Sur Yon, France
| | - Fabio Silvio Taccone
- AfterROSC Network, Nantes, France
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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11
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Laurikkala J, Ameloot K, Reinikainen M, Palmers PJ, De Deyne C, Bert F, Dupont M, Janssens S, Dens J, Hästbacka J, Jakkula P, Loisa P, Birkelund T, Wilkman E, Vaara ST, Skrifvars MB. The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials. Ann Intensive Care 2023; 13:113. [PMID: 37987871 PMCID: PMC10663425 DOI: 10.1186/s13613-023-01210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND We aimed to study the incidence of acute kidney injury (AKI) in out-of-hospital cardiac arrest (OHCA) patients treated according to low-normal or high-normal mean arterial pressure (MAP) targets. METHODS A post hoc analysis of the COMACARE (NCT02698917) and Neuroprotect (NCT02541591) trials that randomized patients to lower or higher targets for the first 36 h of intensive care. Kidney function was defined using the Kidney Disease Improving Global Outcome (KDIGO) classification. We used Cox regression analysis to identify factors associated with AKI after OHCA. RESULTS A total of 227 patients were included: 115 in the high-normal MAP group and 112 in the low-normal MAP group. Eighty-six (38%) patients developed AKI during the first five days; 40 in the high-normal MAP group and 46 in the low-normal MAP group (p = 0.51). The median creatinine and daily urine output were 85 μmol/l and 1730 mL/day in the high-normal MAP group and 87 μmol/l and 1560 mL/day in the low-normal MAP group. In a Cox regression model, independent AKI predictors were no bystander cardiopulmonary resuscitation (p < 0.01), non-shockable rhythm (p < 0.01), chronic hypertension (p = 0.03), and time to the return of spontaneous circulation (p < 0.01), whereas MAP target was not an independent predictor (p = 0.29). CONCLUSION Any AKI occurred in four out of ten OHCA patients. We found no difference in the incidence of AKI between the patients treated with lower and those treated with higher MAP after CA. Higher age, non-shockable initial rhythm, and longer time to ROSC were associated with shorter time to AKI. CLINICAL TRIAL REGISTRATION COMACARE (NCT02698917), NEUROPROTECT (NCT02541591).
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Affiliation(s)
- Johanna Laurikkala
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 9, 00290 HUS, Helsinki, Finland.
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Departement de Cardiologie/Soins Intensifs Adultes, CHC-Montlégia, Liège, Belgique
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Pieter-Jan Palmers
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Departement de Cardiologie/Soins Intensifs Adultes, CHC-Montlégia, Liège, Belgique
| | - Cathy De Deyne
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
- Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ferdinande Bert
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Departement de Cardiologie/Soins Intensifs Adultes, CHC-Montlégia, Liège, Belgique
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Departement de Cardiologie/Soins Intensifs Adultes, CHC-Montlégia, Liège, Belgique
| | - Stefan Janssens
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Departement de Cardiologie/Soins Intensifs Adultes, CHC-Montlégia, Liège, Belgique
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Johanna Hästbacka
- Department of Anesthesia and Intensive Care, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Pekka Jakkula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 9, 00290 HUS, Helsinki, Finland
| | - Pekka Loisa
- Department of Intensive Care, Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 9, 00290 HUS, Helsinki, Finland
| | - Suvi T Vaara
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 9, 00290 HUS, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Lindfors M, Vehviläinen J, Bendel S, Reinikainen M, Laitio R, Ala-Kokko T, Hoppu S, Siironen J, Skrifvars MB, Raj R. Incidence and risk factors of posttraumatic hydrocephalus and its association with outcome following intensive care unit treatment for traumatic brain injury: a multicenter observational study. J Neurosurg 2023; 139:1420-1429. [PMID: 37029677 DOI: 10.3171/2023.2.jns22728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 02/21/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Posttraumatic hydrocephalus (PTH) is a recognized long-term complication of traumatic brain injury (TBI). The authors assessed the incidence and risk factors of PTH and its association with outcome in patients with TBI who were treated in the intensive care unit (ICU). METHODS The authors used the Finnish Intensive Care Consortium (FICC) database to retrospectively identify all adult patients with TBI treated in 4 Finnish tertiary ICUs during 2003-2013. All patients were followed up from hospital discharge to a diagnosis of PTH, death, or the end of 2016. PTH was defined as a need for a postdischarge ventriculoperitoneal or ventriculoatrial shunt. The authors collected data on shunt-insertion procedures, mortality, and disability status from nationwide registries cross-linked to the FICC database. The authors calculated the occurrence and incidence rates of PTH and used multivariable logistic regression modeling to determine risk factors for PTH and its association with outcome. RESULTS Sixty-one of 2882 patients (2.1%) developed PTH during a median follow-up time of 4.6 years, with a median of 102 days (interquartile range 54-220 days) between hospital discharge and PTH. Risk factors for PTH were increasing age (OR 1.02 per year, 95% CI 1.01-1.04); a midline shift of > 5 mm (OR 1.88, 95% CI 1.01-3.48); traumatic subarachnoid hemorrhage (OR 3.59, 95% CI 1.79-7.21); external ventricular drainage (OR 3.54, 95% CI 1.68-7.46); and decompressive craniectomy (OR 3.68, 95% CI 1.37-9.88). PTH was independently associated with permanent disability after case-mix adjustment (OR 3.62, 95% CI 2.11-6.22). CONCLUSIONS PTH is an uncommon long-term complication of TBI, with several risk factors that are identifiable early during neurointensive care. The development of PTH is independently associated with poor functional outcome. Whether earlier detection and treatment of PTH leads to improved outcomes remains unknown, highlighting the importance of adequate follow-up and prompt detection and treatment of the condition.
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Affiliation(s)
- Matias Lindfors
- 1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Juho Vehviläinen
- 1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Stepani Bendel
- 3Department of Anesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Matti Reinikainen
- 3Department of Anesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Ruut Laitio
- 4Department of Intensive Care, Turku University Hospital and University of Turku
| | - Tero Ala-Kokko
- 5Department of Intensive Care, Oulu University Hospital and University of Oulu, Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, Oulu; and
| | - Sanna Hoppu
- 6Department of Intensive Care and Emergency Medical Services, Tampere University Hospital and University of Tampere, Finland
| | - Jari Siironen
- 1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Markus B Skrifvars
- 2Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Rahul Raj
- 1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki
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13
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Reintam Blaser A, Alhazzani W, Belley-Cote E, Møller MH, Adhikari NKJ, Burry L, Coopersmith CM, Al Duhailib Z, Fujii T, Granholm A, Gunst J, Hammond N, Ke L, Lamontagne F, Loudet C, Morgan M, Ostermann M, Reinikainen M, Rosenfeld R, Spies C, Oczkowski S. Intravenous vitamin C therapy in adult patients with sepsis: A rapid practice guideline. Acta Anaesthesiol Scand 2023; 67:1423-1431. [PMID: 37500083 DOI: 10.1111/aas.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/25/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND This Rapid Practice Guideline provides an evidence-based recommendation to address the question: in adults with sepsis or septic shock, should we recommend using or not using intravenous vitamin C therapy? METHODS The panel included 21 experts from 16 countries and used a strict policy for potential financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. Based on an updated systematic review, and the grading of recommendations, assessment, development, and evaluation approach, we evaluated the certainty of evidence and developed recommendations using the evidence-to-decision framework. We conducted an electronic vote, requiring >80% agreement among the panel for a recommendation to be adopted. RESULTS At longest follow-up, 90 days, intravenous vitamin C probably does not substantially impact (relative risk 1.05, 95% confidence interval [CI] 0.94 to 1.17; absolute risk difference 1.8%, 95% CI -2.2 to 6.2; 6 trials, n = 2148, moderate certainty). Effects of vitamin C on mortality at earlier timepoints was of low or very low certainty due to risk of bias of the included studies and significant heterogeneity between study results. Few adverse events were reported with the use of vitamin C. The panel did not identify any major differences in other outcomes, including duration of mechanical ventilation, ventilator free days, hospital or intensive care unit length of stay, acute kidney injury, need for renal replacement therapy. Vitamin C may result in a slight reduction in duration of vasopressor support (MD -18.9 h, 95% CI -26.5 to -11.4; 21 trials, n = 2661, low certainty); but may not reduce sequential organ failure assessment scores (MD -0.69, 95% CI -1.55 to 0.71; 24 trials, n = 4002, low certainty). The panel judged the undesirable consequences of using IV vitamin C to probably outweigh the desirable consequences, and therefore issued a conditional recommendation against using IV vitamin C therapy in sepsis. CONCLUSIONS The panel suggests against use of intravenous vitamin C in adult patients with sepsis, beyond that of standard nutritional supplementation. Small and single center trials on this topic should be discouraged.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- GUIDE Group, Hamilton, Canada
| | - Emilie Belley-Cote
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- GUIDE Group, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - Morten Hylander Møller
- GUIDE Group, Hamilton, Canada
- Department of Intensive Care, University of Copenhagen, Copenhagen, Denmark
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lisa Burry
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto and Sinai Health System, Toronto, Canada
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Georgia
| | - Zainab Al Duhailib
- GUIDE Group, Hamilton, Canada
- Critical Care Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tomoko Fujii
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Anders Granholm
- GUIDE Group, Hamilton, Canada
- Department of Intensive Care, University of Copenhagen, Copenhagen, Denmark
| | - Jan Gunst
- Laboratory of Intensive-Care Medicine, Department of Cellular and Molecular Medicine, Leuven, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Naomi Hammond
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, Australia
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | | | - Cecilia Loudet
- Intensive Care Unit, Hospital Interzonal General de Agudos General San Martín de La Plata, Buenos Aires, Argentina
- Department of Internal Medicine, Applied Pharmacology and Intensive Care, University of La Plata, La Plata, Argentina
| | - Matt Morgan
- Intensive Care Medicine Consultant, The Royal Perth Hospital, Perth, Australia
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Matti Reinikainen
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Ricardo Rosenfeld
- Nutrition Support Team, Casa de Saude Sao Jose-Rede Santa Catarina, Rio de Janeiro, Brazil
| | - Claudia Spies
- Department for Anesthesiology and Intensive Care Medicine, Campus-Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Oczkowski
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- GUIDE Group, Hamilton, Canada
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14
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Pölkki A, Pekkarinen PT, Lahtinen P, Koponen T, Reinikainen M. Vasoactive Inotropic Score compared to the sequential organ failure assessment cardiovascular score in intensive care. Acta Anaesthesiol Scand 2023; 67:1219-1228. [PMID: 37278095 DOI: 10.1111/aas.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The cardiovascular component of the sequential organ failure assessment (cvSOFA) score may be outdated because of changes in intensive care. Vasoactive Inotropic Score (VIS) represents the weighted sum of vasoactive and inotropic drugs. We investigated the association of VIS with mortality in the general intensive care unit (ICU) population and studied whether replacing cvSOFA with a VIS-based score improves the accuracy of the SOFA score as a predictor of mortality. METHODS We studied the association of VIS during the first 24 h after ICU admission with 30-day mortality in a retrospective study on adult medical and non-cardiac emergency surgical patients admitted to Kuopio University Hospital ICU, Finland, in 2013-2019. We determined the area under the receiver operating characteristic curve (AUROC) for the original SOFA and for SOFAVISmax , where cvSOFA was replaced with maximum VIS (VISmax ) categories. RESULTS Of 8079 patients, 1107 (13%) died within 30 days. Mortality increased with increasing VISmax . AUROC was 0.813 (95% confidence interval [CI], 0.800-0.825) for original SOFA and 0.822 (95% CI: 0.810-0.834) for SOFAVISmax , p < .001. CONCLUSION Mortality increased consistently with increasing VISmax . Replacing cvSOFA with VISmax improved the predictive accuracy of the SOFA score.
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Affiliation(s)
- Anssi Pölkki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pasi Lahtinen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koponen
- Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Joensuu, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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15
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Wetterslev M, Hylander Møller M, Granholm A, Hassager C, Haase N, Lange T, Myatra SN, Hästbacka J, Arabi YM, Shen J, Cronhjort M, Lindqvist E, Aneman A, Young PJ, Szczeklik W, Siegemund M, Koster T, Aslam TN, Bestle MH, Girkov MS, Kalvit K, Mohanty R, Mascarenhas J, Pattnaik M, Vergis S, Haranath SP, Shah M, Joshi Z, Wilkman E, Reinikainen M, Lehto P, Jalkanen V, Pulkkinen A, An Y, Wang G, Huang L, Huang B, Liu W, Gao H, Dou L, Li S, Yang W, Tegnell E, Knight A, Czuczwar M, Czarnik T, Perner A. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Crit Care Med 2023; 51:1124-1137. [PMID: 37078722 DOI: 10.1097/ccm.0000000000005883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN Multicenter, prospective, inception cohort study. SETTING Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Sheila N Myatra
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yaseen M Arabi
- Department of Intensive Care Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jiawei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Maria Cronhjort
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Aneman
- Department of Intensive Care Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Clinical School, University of New South Wales, Warwick Farm, NSW, Australia
| | - Paul J Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Siegemund
- Intensive Care Medicine, Department of Acute Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thijs Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tayyba Naz Aslam
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mia S Girkov
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Mohanty
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Joanne Mascarenhas
- Department of Medicine and Critical Care, Breach Candy Hospital Trust, Mumbai, India
| | - Manoranjan Pattnaik
- Department of Pulmonary Medicine, SCB Medical College & Hospital, Cuttack, India
| | - Sara Vergis
- Department of Anaesthesia and Critical Care, MOSC Medical College, Kolenchery, India
| | | | - Mehul Shah
- Department of Critical Care Medicine, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Ziyokov Joshi
- Department of Cardiac Anaesthesiology and Critical Care, Tagore Hospital, Jalandhar, India
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Lehto
- Department of Anaesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Anni Pulkkinen
- Department of Anesthesia and Intensive Care, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Guoxing Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Huang
- Department of Intensive Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bin Huang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Liu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hengbo Gao
- Department of Critical Care Medicine, The Second Hospital, Hebei Medical University, Hebei, China
| | - Lin Dou
- Department of Intensive Care Medicine, Tianjin First Center Hospital, Tianjin, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Wanchun Yang
- Emergency Intensive Care Unit, Xinjiang Production and Construction Crops 13 div Red Star Hospital
| | - Emily Tegnell
- Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnes Knight
- Department of Anaesthesia and Intensive Care, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Miroslaw Czuczwar
- Second Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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16
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Niemelä V, Siddiqui F, Ameloot K, Reinikainen M, Grand J, Hästbacka J, Hassager C, Kjaergard J, Åneman A, Tiainen M, Nielsen N, Harboe Olsen M, Kamp Jorgensen C, Juul Petersen J, Dankiewicz J, Saxena M, Jakobsen JC, Skrifvars MB. Higher versus lower blood pressure targets after cardiac arrest: systematic review with individual patient data meta-analysis. Resuscitation 2023:109862. [PMID: 37295549 DOI: 10.1016/j.resuscitation.2023.109862] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/11/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Guidelines recommend targeting mean arterial pressure (MAP) > 65 mmHg in patients after cardiac arrest (CA). Recent trials have studied the effects of targeting a higher MAP as compared to a lower MAP after CA. We performed a systematic review and individual patient data meta-analysis to investigate the effects of higher versus lower MAP targets on patient outcome. METHOD We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS, BIOSIS, CINAHL, Scopus, the Web of Science Core Collection, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry, Google Scholar and the Turning Research into Practice database to identify trials randomizing patients to higher (≥ 71 mmHg) or lower (≤70 mmHg) MAP targets after CA and resuscitation. We used the Cochrane Risk of Bias tool, version 2 (RoB 2) to assess for risk of bias. The primary outcomes were 180-day all-cause mortality and poor neurologic recovery defined by a modified Rankin score of 4-6 or a cerebral performance category score of 3-5. RESULTS Four eligible clinical trials were identified, randomizing a total of 1,087 patients. All the included trials were assessed as having a low risk for bias. The risk ratio (RR) with 95% confidence interval for 180-day all-cause mortality for a higher versus a lower MAP target was 1.08 (0.92-1.26) and for poor neurologic recovery 1.01 (0.86-1.19). Trial sequential analysis showed that a 25% or higher treatment effect, i.e., RR<0.75, can be excluded. No difference in serious adverse events was found between the higher and lower MAP groups. CONCLUSIONS Targeting a higher MAP compared to a lower MAP is unlikely to reduce mortality or improve neurologic recovery after CA. Only a large treatment effect above 25% (RR<0.75) could be excluded, and future studies are needed to investigate if relevant but lower treatment effect exists. Targeting a higher MAP was not associated with any increase in adverse effects.
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Affiliation(s)
- Ville Niemelä
- Department of Anaesthesia and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Faiza Siddiqui
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Johannes Grand
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Johanna Hästbacka
- Department of Anaesthesiology and Intensive Care, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjaergard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anders Åneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, South Western Clinical School, University of New South Wales, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Niklas Nielsen
- Lund University and Department of Clinical Sciences Lund, Anaesthesia and Intensive Care, Helsingborg Hospital, Lund, Sweden; Skåne University Hospital, Clinical Studies Sweden - Forum South, Lund, Sweden; Anaesthesia and Intensive Care, Helsingborg Hospital, Lund, Sweden
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Caroline Kamp Jorgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Johanne Juul Petersen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Josef Dankiewicz
- Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Manoj Saxena
- South Western Clinical School, University of New South Wales, Sydney, Australia; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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17
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Wihersaari L, Reinikainen M, Tiainen M, Bendel S, Kaukonen KM, Vaahersalo J, Romppanen J, Pettilä V, Skrifvars MB. Ubiquitin C-terminal hydrolase L1 after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2023. [PMID: 37118921 DOI: 10.1111/aas.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/14/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND We studied the prognostic ability of serum ubiquitin C-terminal hydrolase L1 (UCH-L1) after out-of-hospital cardiac arrest (OHCA), compared to that of neuron-specific enolase (NSE). METHODS In this post-hoc analysis of the FINNRESUSCI study, we measured serum concentrations of UCH-L1 in 249 OHCA patients treated in 21 Finnish intensive care units in 2010-2011. We evaluated the ability of UCH-L1 to predict unfavourable outcome at 12 months (defined as cerebral performance category 3-5) by assessing the area under the receiver operating characteristic curve (AUROC), in comparison with NSE. RESULTS The concentrations of UCH-L1 were higher in patients with unfavourable outcome than for those with favourable outcome: median concentration 10.8 ng/mL (interquartile range, 7.5-18.5 ng/mL) versus 7.8 ng/mL (5.9-11.8 ng/mL) at 24 h (p < .001), and 16.2 ng/mL (12.2-27.7 ng/mL) versus 11.5 ng/mL (9.0-17.2 ng/mL) (p < .001) at 48 h after OHCA. For UCH-L1 as a 12-month outcome predictor, the AUROC was 0.66 (95% confidence interval, 0.60-0.73) at 24 h and 0.66 (0.59-0.74) at 48 h. For NSE, the AUROC was 0.66 (0.59-0.73) at 24 h and 0.72 (0.65-0.80) at 48 h. The prognostic ability of UCH-L1 was not different from that of NSE at 24 h (p = .82) and at 48 h (p = .23). CONCLUSION Concentrations of UCH-L1 in serum were higher in patients with unfavourable outcome than in those with favourable outcome. However, the ability of UCH-L1 to predict unfavourable outcome after OHCA was only moderate and not superior to that of NSE.
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Affiliation(s)
- Lauri Wihersaari
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Marjaana Tiainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi-Maija Kaukonen
- University of Helsinki, Helsinki, Finland
- Medbase Developments LTD, Turku, Finland
| | - Jukka Vaahersalo
- Center for Emergency, Perioperative and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
| | | | - Ville Pettilä
- Department of Perioperative and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Pekkarinen PT, Carbone F, Minetti S, Ramoni D, Ristagno G, Latini R, Wihersaari L, Blennow K, Zetterberg H, Toppila J, Jakkula P, Reinikainen M, Montecucco F, Skrifvars MB. Markers of neutrophil mediated inflammation associate with disturbed continuous electroencephalogram after out of hospital cardiac arrest. Acta Anaesthesiol Scand 2023; 67:94-103. [PMID: 36053856 PMCID: PMC10087484 DOI: 10.1111/aas.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/06/2022] [Accepted: 08/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Achieving an acceptable neurological outcome in cardiac arrest survivors remains challenging. Ischemia-reperfusion injury induces inflammation, which may cause secondary neurological damage. We studied the association of ICU admission levels of inflammatory biomarkers with disturbed 48-hour continuous electroencephalogram (cEEG), and the association of the daily levels of these markers up to 72 h with poor 6-month neurological outcome. METHODS This is an observational, post hoc sub-study of the COMACARE trial. We measured serum concentrations of procalcitonin (PCT), high-sensitivity C-reactive protein (hsCRP), osteopontin (OPN), myeloperoxidase (MPO), resistin, and proprotein convertase subtilisin/kexin type 9 (PCSK9) in 112 unconscious, mechanically ventilated ICU-treated adult OHCA survivors with initial shockable rhythm. We used grading of 48-hour cEEG monitoring as a measure for the severity of the early neurological disturbance. We defined 6-month cerebral performance category (CPC) 1-2 as good and CPC 3-5 as poor long-term neurological outcome. We compared the prognostic value of biomarkers for 6-month neurological outcome to neurofilament light (NFL) measured at 48 h. RESULTS Higher OPN (p = .03), MPO (p < .01), and resistin (p = .01) concentrations at ICU admission were associated with poor grade 48-hour cEEG. Higher levels of ICU admission OPN (OR 3.18; 95% CI 1.25-8.11 per ln[ng/ml]) and MPO (OR 2.34; 95% CI 1.30-4.21) were independently associated with poor 48-hour cEEG in a multivariable logistic regression model. Poor 6-month neurological outcome was more common in the poor cEEG group (63% vs. 19% p < .001, respectively). We found a significant fixed effect of poor 6-month neurological outcome on concentrations of PCT (F = 7.7, p < .01), hsCRP (F = 4.0, p < .05), and OPN (F = 5.6, p < .05) measured daily from ICU admission to 72 h. However, the biomarkers did not have independent predictive value for poor 6-month outcome in a multivariable logistic regression model with 48-hour NFL. CONCLUSION Elevated ICU admission levels of OPN and MPO predicted disturbances in cEEG during the subsequent 48 h after cardiac arrest. Thus, they may provide early information about the risk of secondary neurological damage. However, the studied inflammatory markers had little value for long-term prognostication compared to 48-hour NFL.
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Affiliation(s)
- Pirkka T Pekkarinen
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Federico Carbone
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Silvia Minetti
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Davide Ramoni
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Latini
- Cardiovascular Medicine, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Lauri Wihersaari
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Jussi Toppila
- Department of Clinical Neurophysiology, Medical Imaging Center, Helsinki University Central Hospital and Department of Clinical Neurosciences (Neurophysiology), University of Helsinki, Helsinki, Finland
| | - Pekka Jakkula
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Fabrizio Montecucco
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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19
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Olsen MH, Jensen AKG, Dankiewicz J, Skrifvars MB, Reinikainen M, Tiainen M, Saxena M, Aneman A, Gluud C, Ullén S, Nielsen N, Jakobsen JC. Interactions in the 2×2×2 factorial randomised clinical STEPCARE trial and the potential effects on conclusions: a protocol for a simulation study. Trials 2022; 23:889. [PMID: 36273179 PMCID: PMC9587583 DOI: 10.1186/s13063-022-06796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background
Randomised clinical trials with a factorial design may assess the effects of multiple interventions in the same population. Factorial trials are carried out under the assumption that the trial interventions have no interactions on outcomes. Here, we present a protocol for a simulation study investigating the consequences of different levels of interactions between the trial interventions on outcomes for the future 2×2×2 factorial designed randomised clinical Sedation, TEmperature, and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial in comatose patients after out-of-hospital cardiac arrest. Methods By simulating a multisite trial with 50 sites and 3278 participants, and a presumed six-month all-cause mortality of 60% in the control population, we will investigate the validity of the trial results with different levels of interaction effects on the outcome. The primary simulation outcome of the study is the risks of type-1 and type-2 errors in the simulated scenarios, i.e. at what level of interaction is the desired alpha and beta level exceeded. When keeping the overall risk of type-1 errors ≤ 5% and the risk of type-2 errors ≤ 10%, we will quantify the maximum interaction effect we can accept if the planned sample size is increased by 5% to take into account possible interaction between the trial interventions. Secondly, we will assess how interaction effects influence the minimal detectable difference we may confirm or reject to take into account 5% (small interaction effect), 10% (moderate), or 15% (large) positive interactions in simulations with no ‘true’ intervention effect (type-1 errors) and small (5%), moderate (10%), or large negative interactions (15%) in simulations with ‘true’ intervention effects (type-2 errors). Moreover, we will investigate how much the sample size must be increased to account for a small, moderate, or large interaction effects. Discussion This protocol for a simulation study will inform the design of a 2×2×2 factorial randomised clinical trial of how potential interactions between the assessed interventions might affect conclusions. Protocolising this simulation study is important to ensure valid and unbiased results. Trial registration Not relevant
Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06796-7.
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Affiliation(s)
- Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Aksel Karl Georg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josef Dankiewicz
- Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital Lund, Lund, Sweden
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marjaana Tiainen
- Department of Anesthesiology, Intensive Care, and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Manoj Saxena
- Critical Care Division, the George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Anders Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.,South Western Clinical School, University of New South Wales, Sydney, Australia
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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20
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Smeds M, Skrifvars MB, Reinikainen M, Bendel S, Hoppu S, Laitio R, Ala-Kokko T, Curtze S, Sibolt G, Martinez-Majander N, Raj R. One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit. Eur Stroke J 2022; 7:267-279. [PMID: 36082247 PMCID: PMC9446333 DOI: 10.1177/23969873221094705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking. Methods Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs. Results Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs. Conclusions Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.
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Affiliation(s)
- Marika Smeds
- Department of Emergency Care and
Services, Helsinki University Hospital and University of Helsinki, Helsinki,
Finland
| | - Markus B Skrifvars
- Department of Emergency Care and
Services, Helsinki University Hospital and University of Helsinki, Helsinki,
Finland
| | - Matti Reinikainen
- Department of Intensive Care, Kuopio
University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Intensive Care, Kuopio
University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Sanna Hoppu
- Department of Intensive Care, Tampere
University Hospital and University of Tampere, Tampere, Finland
| | - Ruut Laitio
- Department of Department of
Perioperative Services, Intensive Care and Pain Management, Turku University
Hospital and University of Turku, Turku, Finland
| | - Tero Ala-Kokko
- Department of Intensive Care, Oulu
University Hospital and University of Oulu, Oulu, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Rahul Raj
- Department of Neurosurgery, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
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21
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Heikkinen N, Lehtonen J, Keskiväli L, Yim J, Shetty S, Ge Y, Reinikainen M, Putkonen M. Modelling atomic layer deposition overcoating formation on a porous heterogeneous catalyst. Phys Chem Chem Phys 2022; 24:20506-20516. [PMID: 35993759 DOI: 10.1039/d2cp02491h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atomic layer deposition (ALD) was used to deposit a protective overcoating (Al2O3) on an industrially relevant Co-based Fischer-Tropsch catalyst. A trimethylaluminium/water (TMA/H2O) ALD process was used to prepare ∼0.7-2.2 nm overcoatings on an incipient wetness impregnated Co-Pt/TiO2 catalyst. A diffusion-reaction differential equation model was used to predict precursor transport and the resulting deposited overcoating surface coverage inside a catalyst particle. The model was validated against transmission electron (TEM) and scanning electron (SEM) microscopy studies. The prepared model utilised catalyst physical properties and ALD process parameters to estimate achieved overcoating thickness for 20 and 30 deposition cycles (1.36 and 2.04 nm respectively). The TEM analysis supported these estimates, with 1.29 ± 0.16 and 2.15 ± 0.29 nm average layer thicknesses. In addition to layer thickness estimation, the model was used to predict overcoating penetration into the porous catalyst. The model estimated a penetration depth of ∼19 μm, and cross-sectional scanning electron microscopy supported the prediction with a deepest penetration of 15-18 μm. The model successfully estimated the deepest penetration, however, the microscopy study showed penetration depth fluctuation between 0-18 μm, having an average of 9.6 μm.
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Affiliation(s)
- Niko Heikkinen
- VTT Technical Research Centre of Finland, P.O.Box 1000, FIN-02044 VTT, Espoo, Finland.
| | - Juha Lehtonen
- VTT Technical Research Centre of Finland, P.O.Box 1000, FIN-02044 VTT, Espoo, Finland.
| | - Laura Keskiväli
- VTT Technical Research Centre of Finland, P.O.Box 1000, FIN-02044 VTT, Espoo, Finland.
| | - Jihong Yim
- Department of Chemical and Metallurgical Engineering, Aalto University School of Chemical Engineering, Kemistintie 1, Espoo, Finland.
| | - Shwetha Shetty
- University of Helsinki, Department of Chemistry, P.O.Box 55, FIN-00014, Helsinki, Finland.
| | - Yanling Ge
- VTT Technical Research Centre of Finland, P.O.Box 1000, FIN-02044 VTT, Espoo, Finland.
| | - Matti Reinikainen
- VTT Technical Research Centre of Finland, P.O.Box 1000, FIN-02044 VTT, Espoo, Finland.
| | - Matti Putkonen
- University of Helsinki, Department of Chemistry, P.O.Box 55, FIN-00014, Helsinki, Finland.
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22
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Anthon CT, Pène F, Perner A, Azoulay E, Puxty K, Van De Louw A, Barret‐Due A, Chawla S, Castro P, Povoa P, Coelho L, Metaxa V, Munshi L, Kochanek M, Liebregts T, Kander T, Hästbacka J, Møller MH, Russell L, Anthon CT, Hildebrandt T, Vogelius MK, Clausen N, Bestle M, Lorentzen K, Nielsen LB, Andreasen JB, Hvas CL, Juhl CS, Lundqvist L, Lindquist E, Barret‐Due A, Bådstøløkken PM, Holten AR, Kvåle R, Strand K, Klepstad P, Hästbacka J, Jalkanen V, Reinikainen M, Péju E, Marin N, Pène F, Vimpere D, Menat S, Voiriot G, Schmidt J, Dufranc E, Uhel F, Lafarge A, Missri L, Ait‐Oufella H, Canet E, Metexa V, Puxty K, Wright C, Castro P, Costa C, Coelho L, Povoa P, Paulino MC, Graça C, Torres JCS, Chawla S, Voigt L, Van de Louw A, Munshi L, Lueck C, Kochanek M, Liebgrets T. Platelet transfusions and thrombocytopenia in intensive care units: protocol for an international inception cohort study (PLOT‐ICU). Acta Anaesthesiol Scand 2022; 66:1146-1155. [PMID: 36054145 PMCID: PMC9542787 DOI: 10.1111/aas.14124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
Introduction Thrombocytopenia is frequent in intensive care unit (ICU) patients and has been associated with worse outcome. Platelet transfusions are often used in the management of ICU patients with severe thrombocytopenia. However, the reported frequencies of thrombocytopenia and platelet transfusion practices in the ICU vary considerably. Therefore, we aim to provide contemporary epidemiological data on thrombocytopenia and platelet transfusion practices in the ICU. Methods We will conduct an international inception cohort, including at least 1000 acutely admitted adult ICU patients. Routinely available data will be collected at baseline (ICU admission), and daily during ICU stay up to a maximum of 90 days. The primary outcome will be the number of patients with thrombocytopenia (a recorded platelet count < 150 × 109/L) at baseline and/or during ICU stay. Secondary outcomes include mortality, days alive and out of hospital, days alive without life‐support, the number of patients with at least one bleeding episode, at least one thromboembolic event and at least one platelet transfusion in the ICU, the number of platelet transfusions and the indications for transfusion. The primary and secondary outcomes will be presented descriptively. In addition, we will assess risk factors for developing thrombocytopenia during ICU stay and the association between thrombocytopenia at baseline and 90‐day mortality using logistic regression analyses. Conclusion The outlined international PLOT‐ICU cohort study will provide contemporary epidemiological data on the burden and clinical significance of thrombocytopenia in adult ICU patients and describe the current platelet transfusion practice.
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Affiliation(s)
- Carl Thomas Anthon
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Frédéric Pène
- Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris Université Paris Cité Paris France
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint‐Louis, Assistance Publique – Hôpitaux de Paris Université Paris Cité Paris France
| | - Kathryn Puxty
- Department of Intensive Care Glasgow Royal Infirmary Glasgow United Kingdom
| | - Andry Van De Louw
- Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA USA
| | - Andreas Barret‐Due
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet Oslo University Hospital Oslo Norway
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine Memorial Sloan Kettering Cancer Center New York NY USA
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona; IDIBAPS; University of Barcelona Barcelona Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal and NOVA Medical School New University of Lisbon Lisbon Portugal
| | - Luis Coelho
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal and NOVA Medical School New University of Lisbon Lisbon Portugal
| | - Victoria Metaxa
- Department of Critical Care King's College Hospital NHS Foundation Trust London United Kingdom
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network University of Toronto Toronto Ontario Canada
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany
| | - Tobias Liebregts
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Sweden and Department of Clinical Sciences Lund University Sweden
| | - Johanna Hästbacka
- Department of Perioperative, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Lene Russell
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
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23
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Skrifvars MB, Ameloot K, Grand J, Reinikainen M, Hästbacka J, Niemelä V, Hassager C, Kjaergaard J, Åneman A, Tiainen M, Nielsen N, Ullen S, Dankiewicz J, Olsen MH, Jørgensen CK, Saxena M, Jakobsen JC. Protocol for an individual patient data meta-analysis on blood pressure targets after cardiac arrest. Acta Anaesthesiol Scand 2022; 66:890-897. [PMID: 35616252 PMCID: PMC9543739 DOI: 10.1111/aas.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Background Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. Methods This systematic review and meta‐analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight‐step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all‐cause mortality, functional long‐term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta‐analysis, aggregate data meta‐analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. Conclusions This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub‐groups differences.
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Affiliation(s)
- Markus B. Skrifvars
- Department of Emergency Care and Services Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Koen Ameloot
- Department of Cardiology Ziekenhuis Oost‐Limburg Genk Belgium
- Department of Cardiology University Hospitals Leuven Leuven Belgium
- Faculty of Medicine and Life Sciences University Hasselt Diepenbeek Belgium
| | - Johannes Grand
- Department of Cardiology Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Matti Reinikainen
- Department of Intensive Care Kuopio University Hospital and University of Eastern Finland Kuopio Finland
| | - Johanna Hästbacka
- Department of Anesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Ville Niemelä
- Department of Anesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Jesper Kjaergaard
- Department of Cardiology Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Anders Åneman
- Intensive Care Unit Liverpool Hospital, South Western Sydney Local Health District Sydney Australia
- University of New South Wales Sydney Australia
- Faculty of Medicine and Health Sciences Macquarie University Sydney Australia
| | - Marjaana Tiainen
- Department of Neurology Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Niklas Nielsen
- Department of Clinical Sciences Lund University Lund Sweden
- Anaesthesia and Intensive Care Helsingborg Hospital Lund Sweden
| | - Susann Ullen
- Skåne University Hospital Clinical Studies Sweden – Forum South Lund Sweden
| | - Josef Dankiewicz
- Department of Clinical Sciences, Lund, Section of Cardiology Skåne University Hospital Lund, Lund University and Clinical Studies Lund Sweden
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Caroline Kamp Jørgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Manoj Saxena
- South Western Clinical School University of New South Wales Sydney Australia
- Critical Care Division, the George Institute for Global Health University of New South Wales Sydney Australia
| | - Janus C. Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Department of Regional Health Research, Faculty of Health Sciences University of Southern Denmark Odense Denmark
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24
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Adamski J, Weigl W, Musialowicz T, Lahtinen P, Reinikainen M. Predictors of treatment limitations in Finnish intensive care units. Acta Anaesthesiol Scand 2022; 66:526-538. [PMID: 35118641 DOI: 10.1111/aas.14035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/02/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have examined the factors that predict the limitations of life-sustaining treatment (LST) to patients in intensive care units (ICUs). We aimed to identify variables associated with the decision of withholding of life support (WHLS) at admission, WHLS during ICU stay and the withdrawal of ongoing life support (WDLS). METHODS This retrospective observational study comprised 17,772 adult ICU patients who were included in the nationwide Finnish ICU Registry in 2016. Factors associated with LST limitations were identified using hierarchical logistic regression. RESULTS The decision of WHLS at admission was made for 822 (4.6%) patients, WHLS during ICU stay for 949 (5.3%) patients, and WDLS for 669 (3.8%) patients. Factors strongly predicting WHLS at admission included old age (adjusted odds ratio [OR] for patients aged 90 years or older in reference to those younger than 40 years was 95.6; 95% confidence interval [CI], 47.2-193.5), dependence on help for activities of daily living (OR, 3.55; 95% CI, 3.01-4.2), and metastatic cancer (OR, 4.34; 95% CI, 3.16-5.95). A high severity of illness predicted later decisions to limit LST. Diagnoses strongly associated with WHLS at admission were cardiac arrest, hepatic failure and chronic obstructive pulmonary disease. Later decisions were strongly associated with cardiac arrest, hepatic failure, non-traumatic intracranial hemorrhage, head trauma and stroke. CONCLUSION Early decisions to limit LST were typically associated with old age and chronic poor health whereas later decisions were related to the severity of illness. Limitations are common for certain diagnoses, particularly cardiac arrest and hepatic failure.
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Affiliation(s)
- Jan Adamski
- Department of Anaesthesiology and Intensive Care Faculty of Medical Sciences University of Warmia and Mazury in Olsztyn Olsztyn Poland
| | - Wojciech Weigl
- Anaesthesiology and Intensive Care Department of Surgical Sciences Akademiska Hospital Uppsala University Uppsala Sweden
| | - Tadeusz Musialowicz
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Pasi Lahtinen
- Anaesthesiology and Intensive Care Department Central Hospital of South Ostrobothnia Seinäjoki Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
- Faculty of Health Sciences School of Medicine Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
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25
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Pölkki A, Pekkarinen PT, Takala J, Selander T, Reinikainen M. Association of Sequential Organ Failure Assessment (SOFA) components with mortality. Acta Anaesthesiol Scand 2022; 66:731-741. [PMID: 35353902 PMCID: PMC9322581 DOI: 10.1111/aas.14067] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sequential Organ Failure Assessment (SOFA) is a practical method to describe and quantify the presence and severity of organ system dysfunctions and failures. Some proposals suggest that SOFA could be employed as an endpoint in trials. To justify this, all SOFA component scores should reflect organ dysfunctions of comparable severity. We aimed to investigate whether the associations of different SOFA components with in-hospital mortality are comparable. METHODS We performed a study based on nationwide register data on adult patients admitted to 26 Finnish intensive care units (ICUs) during 2012-2015. We determined the SOFA score as the maximum score in the first 24 hours after ICU admission. We defined organ failure (OF) as an organ-specific SOFA score of three or higher. We evaluated the association of different SOFA component scores with mortality. RESULTS Our study population comprised 63,756 ICU patients. Overall hospital mortality was 10.7%. In-hospital mortality was 22.5% for patients with respiratory failure, 34.8% for those with coagulation failure, 40.1% for those with hepatic failure, 14.9% for those with cardiovascular failure, 26.9% for those with neurologic failure and 34.6% for the patients with renal failure. Among patients with comparable total SOFA scores, the risk of death was lower in patients with cardiovascular OF compared with patients with other OFs. CONCLUSIONS All SOFA components are associated with mortality, but their weights are not comparable. High scores of other organ systems mean a higher risk of death than high cardiovascular scores. The scoring of cardiovascular dysfunction needs to be updated.
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Affiliation(s)
- Anssi Pölkki
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
- University of Eastern Finland Kuopio Finland
| | - Pirkka T. Pekkarinen
- Division of Intensive Care Medicine Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Jukka Takala
- Department of Intensive Care Medicine University Hospital Bern (Inselspital) University of Bern Bern Switzerland
| | - Tuomas Selander
- Science Service Center Kuopio University Hospital Kuopio Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
- University of Eastern Finland Kuopio Finland
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26
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Heikkinen N, Keskiväli L, Palo J, Reinikainen M, Putkonen M. Effect of Co-fed Water on a Co-Pt-Si/γ-Al 2O 3 Fischer-Tropsch Catalyst Modified with an Atomic Layer Deposited or Molecular Layer Deposition Overcoating. ACS Omega 2022; 7:7725-7736. [PMID: 35284741 PMCID: PMC8908501 DOI: 10.1021/acsomega.1c06512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Atomic layer deposition (ALD) and molecular layer deposition (MLD) methods were used to prepare overcoatings on a cobalt-based Fischer-Tropsch catalyst. A Co-Pt-Si/γ-Al2O3 catalyst (21.4 wt % Co, 0.2 wt % Pt, and 1.6 wt % Si) prepared by incipient wetness impregnation was ALD overcoated with 30-40 cycles of trimethylaluminum (TMA) and water, followed by temperature treatment (420 °C) in an inert nitrogen atmosphere. MLD-overcoated samples with corresponding film thicknesses were prepared by using TMA and ethylene glycol, followed by temperature treatment (400 °C) in an oxidative synthetic air atmosphere. The ALD catalyst (40 deposition cycles) had a positive activity effect upon moderate water addition (P H2O/P H2 = 0.42), and compared with a non-overcoated catalyst, it showed resistance to irreversible deactivation after co-fed water conditions. In addition, MLD overcoatings had a positive effect on the catalyst activity upon moderate water addition. However, compared with a non-overcoated catalyst, only the 10-cycle MLD-overcoated catalyst retained increased activity throughout high added water conditions (P H2O/P H2 = 0.71). All catalyst variations exhibited irreversible deactivation under high added water conditions.
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Affiliation(s)
- Niko Heikkinen
- VTT
Technical Research Centre of Finland,
P.O.Box 1000, FIN-02044 VTT, Espoo, Finland
| | - Laura Keskiväli
- VTT
Technical Research Centre of Finland,
P.O.Box 1000, FIN-02044 VTT, Espoo, Finland
| | - Jasmiina Palo
- VTT
Technical Research Centre of Finland,
P.O.Box 1000, FIN-02044 VTT, Espoo, Finland
| | - Matti Reinikainen
- VTT
Technical Research Centre of Finland,
P.O.Box 1000, FIN-02044 VTT, Espoo, Finland
| | - Matti Putkonen
- Department
of Chemistry, University of Helsinki, P.O.Box 55, FIN-00014 Helsinki, Finland
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27
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Wetterslev M, Møller MH, Granholm A, Hassager C, Haase N, Aslam TN, Shen J, Young PJ, Aneman A, Hästbacka J, Siegemund M, Cronhjort M, Lindqvist E, Myatra SN, Kalvit K, Arabi YM, Szczeklik W, Sigurdsson MI, Balik M, Keus F, Perner A, Huang B, Yan M, Liu W, Deng Y, Zhang L, Suk P, Mørk Sørensen K, Andreasen AS, Bestle MH, Krag M, Poulsen LM, Hildebrandt T, Møller K, Møller‐Sørensen H, Bove J, Kilsgaard TA, Salam IA, Brøchner AC, Strøm T, Sølling C, Kolstrup L, Boczan M, Rasmussen BS, Darfelt IS, Jalkanen V, Lehto P, Reinikainen M, Kárason S, Sigvaldason K, Olafsson O, Vergis S, Mascarenhas J, Shah M, Haranath SP, Van Der Poll A, Gjerde S, Fossum OK, Strand K, Wangberg HL, Berta E, Balsliemke S, Robertson AC, Pedersen R, Dokka V, Brügger‐Synnes P, Czarnik T, Albshabshe AA, Almekhlafi G, Knight A, Tegnell E, Sjövall F, Jakob S, Filipovic M, Kleger G, Eck RJ. Management of acute atrial fibrillation in the intensive care unit: An international survey. Acta Anaesthesiol Scand 2022; 66:375-385. [PMID: 34870855 DOI: 10.1111/aas.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. METHOD We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. RESULTS A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. CONCLUSION This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Nicolai Haase
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Tayyba Naz Aslam
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Oslo University Hospital Oslo Norway
| | - Jiawei Shen
- Department of Critical Care Medicine Peking University People's Hospital Beijing China
| | - Paul J. Young
- Intensive Care Specialist and co‐Director, Intensive Care Unit Wellington Hospital Wellington New Zealand
- Intensive Care Programme Director Medical Research Institute of New Zealand Wellington New Zealand
- Australian and New Zealand Intensive Care Research Centre Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Anders Aneman
- Department of Intensive Care Medicine Liverpool Hospital South Western Sydney Local Health District and South Western Sydney Clinical School University of New South Wales Sydney Australia
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Martin Siegemund
- Department of Intensive Care Medicine Department of Clinical Research University Hospital Basel and University of Basel Basel Switzerland
| | - Maria Cronhjort
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education Section of Anaesthesia and Intensive Care Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Sheila N. Myatra
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai India
| | - Yaseen M. Arabi
- Department of Intensive Care Medicine Ministry of National Guard Health Affairs King Saud bin Abdulaziz University for Health Sciences King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Kraków Poland
| | - Martin I. Sigurdsson
- Division of Anaesthesia and Intensive Care Perioperative Services at Landspitali The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Martin Balik
- Department of Anesthesiology and Intensive Care 1st Faculty of Medicine General University Hospital Charles University Prague Czech Republic
| | - Frederik Keus
- Department of Critical Care University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Anders Perner
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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28
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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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Pietiläinen L, Bäcklund M, Hästbacka J, Reinikainen M. Premorbid functional status as an outcome predictor in intensive care patients aged over 85 years. BMC Geriatr 2022; 22:38. [PMID: 35012458 PMCID: PMC8751370 DOI: 10.1186/s12877-021-02746-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 12/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor premorbid functional status (PFS) is associated with mortality after intensive care unit (ICU) admission in patients aged 80 years or older. In the subgroup of very old ICU patients, the ability to recover from critical illness varies irrespective of age. To assess the predictive ability of PFS also among the patients aged 85 or older we set out the current study. METHODS In this nationwide observational registry study based on the Finnish Intensive Care Consortium database, we analysed data of patients aged 85 years or over treated in ICUs between May 2012 and December 2015. We defined PFS as good for patients who had been independent in activities of daily living (ADL) and able to climb stairs and as poor for those who were dependent on help or unable to climb stairs. To assess patients' functional outcome one year after ICU admission, we created a functional status score (FSS) based on how many out of five physical activities (getting out of bed, moving indoors, dressing, climbing stairs, and walking 400 m) the patient could manage. We also assessed the patients' ability to return to their previous type of accommodation. RESULTS Overall, 2037 (3.3% of all adult ICU patients) patients were 85 years old or older. The average age of the study population was 87 years. Data on PFS were available for 1446 (71.0%) patients (good for 48.8% and poor for 51.2%). The one-year mortalities of patients with good and those with poor PFS were 29.2% and 50.1%, respectively, p < 0.001. Poor PFS increased the probability of death within 12 months, adjusted odds ratio (OR), 2.15; 95% confidence interval (CI) 1.68-2.76, p < 0.001. For 69.5% of survivors, the FSS one year after ICU admission was unchanged or higher than their premorbid FSS and 84.2% of patients living at home before ICU admission still lived at home. CONCLUSIONS Poor PFS doubled the odds of death within one year. For most survivors, functional status was comparable to the premorbid status.
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Affiliation(s)
- Laura Pietiläinen
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
| | - Minna Bäcklund
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Hästbacka
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- University of Eastern Finland and Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
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Vehviläinen J, Skrifvars M, Reinikainen M, Bendel S, Laitio R, Hoppu S, Ala-Kokko T, Siironen J, Raj R. External validation of the NeuroImaging Radiological Interpretation System and Helsinki computed tomography score for mortality prediction in patients with traumatic brain injury treated in the intensive care unit: a Finnish intensive care consortium study. Acta Neurochir (Wien) 2022; 164:2709-2717. [PMID: 36050580 PMCID: PMC9519640 DOI: 10.1007/s00701-022-05353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Admission computed tomography (CT) scoring systems can be used to objectively quantify the severity of traumatic brain injury (TBI) and aid in outcome prediction. We aimed to externally validate the NeuroImaging Radiological Interpretation System (NIRIS) and the Helsinki CT score. In addition, we compared the prognostic performance of the NIRIS and the Helsinki CT score to the Marshall CT classification and to a clinical model. METHODS We conducted a retrospective multicenter observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003-2013. We analyzed the CT scans using the NIRIS and the Helsinki CT score and compared the results to 6-month mortality as the primary outcome. In addition, we created a clinical model (age, Glasgow Coma Scale score, Simplified Acute Physiology Score II, presence of severe comorbidity) and combined clinical and CT models to see the added predictive impact of radiological data to conventional clinical information. We measured model performance using area under curve (AUC), Nagelkerke's R2 statistics, and the integrated discrimination improvement (IDI). RESULTS A total of 3031 patients were included in the analysis. The 6-month mortality was 710 patients (23.4%). Of the CT models, the Helsinki CT displayed best discrimination (AUC 0.73 vs. 0.70 for NIRIS) and explanatory variation (Nagelkerke's R2 0.20 vs. 0.15). The clinical model displayed an AUC of 0.86 (95% CI 0.84-0.87). All CT models increased the AUC of the clinical model by + 0.01 to 0.87 (95% CI 0.85-0.88) and the IDI by 0.01-0.03. CONCLUSION In patients with TBI treated in the ICU, the Helsinki CT score outperformed the NIRIS for 6-month mortality prediction. In isolation, CT models offered only moderate accuracy for outcome prediction and clinical variables outweighing the CT-based predictors in terms of predictive performance.
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Affiliation(s)
- Juho Vehviläinen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, P.B. 266, 00029 HUS Helsinki, Finland
| | - Markus Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Ruut Laitio
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital & University of Turku, Turku, Finland
| | - Sanna Hoppu
- Department of Intensive Care and Emergency Medicine Services, Department of Emergency, Anesthesia and Pain Medicine, Tampere University Hospital & University of Tampere, Tampere, Finland
| | - Tero Ala-Kokko
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Intensive Care, Medical Research Center, Oulu University Hospital & University of Oulu, Oulu, Finland
| | - Jari Siironen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, P.B. 266, 00029 HUS Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, P.B. 266, 00029 HUS Helsinki, Finland
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Chew MS, Kattainen S, Haase N, Buanes EA, Kristinsdottir LB, Hofsø K, Laake JH, Kvåle R, Hästbacka J, Reinikainen M, Bendel S, Varpula T, Walther S, Perner A, Flaatten HK, Sigurdsson MI. A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries. Acta Anaesthesiol Scand 2022; 66:56-64. [PMID: 34570897 PMCID: PMC8652908 DOI: 10.1111/aas.13983] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/12/2021] [Indexed: 12/15/2022]
Abstract
Background We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID‐19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID‐19 disease during the first wave of COVID‐19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS‐CoV‐2, the ratio of requiring ICU admission for COVID‐19 varied substantially (1.6%–6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID‐19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%–85%) in all countries, the proportion of patients receiving renal replacement therapy (7%–26%) and various experimental therapies for COVID‐19 disease varied substantially (e.g. use of hydroxychloroquine 0%–85%). Crude ICU mortality ranged from 11% to 33%. Conclusion There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID‐19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention.
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Affiliation(s)
- Michelle S. Chew
- Departments of Anaesthesia and Intensive Care Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Salla Kattainen
- Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
- Faculty of Medicine University of Helsinki Helsinki Finland
| | - Nicolai Haase
- Department of Intensive Care Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Eirik A. Buanes
- Norwegian Intensive Care and Pandemic Registry Helse Bergen Health Trust Bergen Norway
| | - Linda B. Kristinsdottir
- Department of Anaesthesiology and Critical Care Perioperative Services Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Kristin Hofsø
- Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
- Lovisenberg Diaconal University College Oslo Norway
| | - Jon Henrik Laake
- Department of Anaesthesiology and Department of Research and Development Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - Reidar Kvåle
- Norwegian Intensive Care RegistryHelse Bergen HF Bergen Norway
- Department of Anesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
- Faculty of Medicine University of Helsinki Helsinki Finland
| | - Matti Reinikainen
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
| | - Stepani Bendel
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
| | - Tero Varpula
- Department of Anaesthesiology, Intensive Care and Pain Medicine Helsinki University Hospital Helsinki Finland
- Faculty of Medicine University of Helsinki Helsinki Finland
| | - Sten Walther
- Swedish Intensive Care RegistryVärmland County Council Karlstad Sweden
- Department of Cardiothoracic and Vascular Surgery Linköping University Hospital Linköping Sweden
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Anders Perner
- Department of Intensive Care Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Hans K. Flaatten
- Norwegian Intensive Care RegistryHelse Bergen HF Bergen Norway
- Department of Anesthesia and Intensive Care Haukeland University Hospital Bergen Norway
| | - Martin I. Sigurdsson
- Department of Anaesthesiology and Critical Care Perioperative Services Landspitali – The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
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Laake JH, Astvad M, Bentsen G, Escher C, Haney M, Hoffmann‐Petersen J, Hyllested M, Junttila E, Møller MH, Nellgård P, Nyberg A, Olkkola K, Pedersen SKA, Pischke SE, Reinikainen M, Strand K, Thorarensen G, Thormar K, Tønnessen TI. A policy for diversity, equity, inclusion and anti-racism in the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI). Acta Anaesthesiol Scand 2022; 66:141-144. [PMID: 34462910 DOI: 10.1111/aas.13978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jon H. Laake
- Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - Mads Astvad
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Gunnar Bentsen
- Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - Cecilia Escher
- Anestesia and Intensive Care Karolinska Institute Stockholm Sweden
| | - Michael Haney
- Anesthesia and Intensive Care Medicine Anesthesiology and Intensive Care Medicine Umeå University and the University Hospital of Umeå, Umeå Universitet Medicinska fakulteten Umeå Sweden
| | | | - Mette Hyllested
- Department of Anaesthesiology Holbæk Hospital Holbæk Denmark
| | - Eija Junttila
- Department of Anaesthesiology and Intensive Care Tampere University Hospital Tampere Finland
| | - Morten H. Møller
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Per Nellgård
- Cardiothoracic Anaesthesia & Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Annette Nyberg
- Department of Anaesthesia and Intensive Care Alingsås Hospital Alingsås Sweden
| | - Klaus Olkkola
- Department of Anaesthesiology Intensive Care University of Helsinki and Helsinki University Central HospitalEmergency Care and Pain Medicine Helsinki Finland
| | - Steffen K. A. Pedersen
- Department of Anaesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Søren E. Pischke
- Division of Critical Care and Emergencies Oslo University Hospital Oslo Norway
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland
| | - Kristian Strand
- Anaesthesia and Intensive Care Helse Stavanger HF Stavanger Norway
| | - Gunnar Thorarensen
- Department of Anaesthesia and Intensive Care Landspitali University Hospital Reykjavik Iceland
| | - Katrin Thormar
- Department of Anaesthesiology Landspitali University Hospital Reykjavik Iceland
| | - Tor I. Tønnessen
- Department of Anesthesiology Oslo University Hospital—Rikshospitalet, and University of Oslo Oslo Norway
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Luostarinen T, Vehviläinen J, Lindfors M, Reinikainen M, Bendel S, Laitio R, Hoppu S, Ala-Kokko T, Skrifvars M, Raj R. Trends in mortality after intensive care of patients with traumatic brain injury in Finland from 2003 to 2019: a Finnish Intensive Care Consortium study. Acta Neurochir (Wien) 2022; 164:87-96. [PMID: 34725728 PMCID: PMC8761133 DOI: 10.1007/s00701-021-05034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
Abstract
Background Several studies have suggested no change in the outcome of patients with traumatic brain injury (TBI) treated in intensive care units (ICUs). This is mainly due to the shift in TBI epidemiology toward older and sicker patients. In Finland, the share of the population aged 65 years and over has increased the most in Europe during the last decade. We aimed to assess changes in 12-month and hospital mortality of patients with TBI treated in the ICU in Finland. Methods We used a national benchmarking ICU database (Finnish Intensive Care Consortium) to study adult patients who had been treated for TBI in four tertiary ICUs in Finland during 2003–2019. We divided admission years into quartiles and used multivariable logistic regression analysis, adjusted for case-mix, to assess the association between admission year and mortality. Results A total of 4535 patients were included. Between 2003–2007 and 2016–2019, the patient median age increased from 54 to 62 years, the share of patients having significant comorbidity increased from 8 to 11%, and patients being dependent on help in activities of daily living increased from 7 to 15%. Unadjusted hospital and 12-month mortality decreased from 18 and 31% to 10% and 23%, respectively. After adjusting for case-mix, a reduction in odds of 12-month and hospital mortality was seen in patients with severe TBI, intracranial pressure monitored patients, and mechanically ventilated patients. Despite a reduction in hospital mortality, 12-month mortality remained unchanged in patients aged ≥ 70 years. Conclusion A change in the demographics of ICU-treated patients with TBI care is evident. The outcome of younger patients with severe TBI appears to improve, whereas long-term mortality of elderly patients with less severe TBI has not improved. This has ramifications for further efforts to improve TBI care, especially among the elderly. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05034-4.
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Affiliation(s)
- Teemu Luostarinen
- Anaesthesiology and Intensive Care, Hyvinkää Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Juho Vehviläinen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matias Lindfors
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Ruut Laitio
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital & University of Turku, Turku, Finland
| | - Sanna Hoppu
- Department of Intensive Care and Emergency Medicine Services, Tampere University Hospital & University of Tampere, Tampere, Finland
| | - Tero Ala-Kokko
- Department of Intensive Care, Oulu University Hospital & University of Oulu, Oulu, Finland
| | - Markus Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lehmuskoski J, Vasama H, Hämäläinen J, Hokkinen J, Kärkelä T, Heiskanen K, Reinikainen M, Rautio S, Hirvelä M, Genoud G. On-Line Monitoring of Radiocarbon Emissions in a Nuclear Facility with Cavity Ring-Down Spectroscopy. Anal Chem 2021; 93:16096-16104. [PMID: 34814685 PMCID: PMC8655739 DOI: 10.1021/acs.analchem.1c03814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
There are currently no suitable methods for sensitive automated in situ monitoring of gaseous radiocarbon, one of the main sources of radioactive gas emissions from nuclear power plants. Here, we present a transportable instrument for in situ airborne radiocarbon detection based on mid-infrared cavity ring-down spectroscopy and report its performance in a 1-week field measurement at the Loviisa nuclear power plant. Radiocarbon is detected by measuring an absorption line of the 14CO2 molecule. The time resolution of the measurements is 45 min, significantly less than the few days' resolution of the currently used technique, while maintaining a comparable sensitivity. The method can also assess the prevalence of radiocarbon in different molecular species in the airborne emissions. The optical in situ monitoring presented is a completely new method for monitoring emissions from nuclear facilities.
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Affiliation(s)
- Johannes Lehmuskoski
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Hannu Vasama
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Jussi Hämäläinen
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Jouni Hokkinen
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Teemu Kärkelä
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Katja Heiskanen
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Matti Reinikainen
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
| | - Satu Rautio
- Fortum
Power & Heat Oy Loviisan Voimalaitos, P.O. Box 23, 07901 Loviisa, Finland
| | - Miska Hirvelä
- Fortum
Power & Heat Oy Loviisan Voimalaitos, P.O. Box 23, 07901 Loviisa, Finland
| | - Guillaume Genoud
- VTT
Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, VTT, Finland
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35
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Moser A, Reinikainen M, Jakob SM, Selander T, Pettilä V, Kiiski O, Varpula T, Raj R, Takala J. Mortality prediction in intensive care units including premorbid functional status improved performance and internal validity. J Clin Epidemiol 2021; 142:230-241. [PMID: 34823021 DOI: 10.1016/j.jclinepi.2021.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Prognostic models are key for benchmarking intensive care units (ICUs). They require up-to-date predictors and should report transportability properties for reliable predictions. We developed and validated an in-hospital mortality risk prediction model to facilitate benchmarking, quality assurance, and health economics evaluation. STUDY DESIGN AND SETTING We retrieved data from the database of an international (Finland, Estonia, Switzerland) multicenter ICU cohort study from 2015 to 2017. We used a hierarchical logistic regression model that included age, a modified Simplified Acute Physiology Score-II, admission type, premorbid functional status, and diagnosis as grouping variable. We used pooled and meta-analytic cross-validation approaches to assess temporal and geographical transportability. RESULTS We included 61,224 patients treated in the ICU (hospital mortality 10.6%). The developed prediction model had an area under the receiver operating characteristic curve 0.886, 95% confidence interval (CI) 0.882-0.890; a calibration slope 1.01, 95% CI (0.99-1.03); a mean calibration -0.004, 95% CI (-0.035 to 0.027). Although the model showed very good internal validity and geographic discrimination transportability, we found substantial heterogeneity of performance measures between ICUs (I-squared: 53.4-84.7%). CONCLUSION A novel framework evaluating the performance of our prediction model provided key information to judge the validity of our model and its adaptation for future use.
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Affiliation(s)
- André Moser
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Ville Pettilä
- Division of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Kiiski
- Health and Care, Benchmarking Services, TietoEvry, Helsinki, Finland
| | - Tero Varpula
- Division of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Takala
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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36
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Laurikkala J, Aneman A, Peng A, Reinikainen M, Pham P, Jakkula P, Hästbacka J, Wilkman E, Loisa P, Toppila J, Birkelund T, Blennow K, Zetterberg H, Skrifvars MB. Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest: a post-hoc analysis of the COMACARE trial. Crit Care 2021; 25:350. [PMID: 34583763 PMCID: PMC8477475 DOI: 10.1186/s13054-021-03764-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) is one feature of post cardiac arrest encephalopathy. We studied the incidence and features of CVR by near infrared spectroscopy (NIRS) and associations with outcome and biomarkers of brain injury. METHODS A post-hoc analysis of 120 comatose OHCA patients continuously monitored with NIRS and randomised to low- or high-normal oxygen, carbon dioxide and mean arterial blood pressure (MAP) targets for 48 h. The tissue oximetry index (TOx) generated by the moving correlation coefficient between cerebral tissue oxygenation measured by NIRS and MAP was used as a dynamic index of CVR with TOx > 0 indicating impaired reactivity and TOx > 0.3 used to delineate the lower and upper MAP bounds for disrupted CVR. TOx was analysed in the 0-12, 12-24, 24-48 h time-periods and integrated over 0-48 h. The primary outcome was the association between TOx and six-month functional outcome dichotomised by the cerebral performance category (CPC1-2 good vs. 3-5 poor). Secondary outcomes included associations with MAP bounds for CVR and biomarkers of brain injury. RESULTS In 108 patients with sufficient data to calculate TOx, 76 patients (70%) had impaired CVR and among these, chronic hypertension was more common (58% vs. 31%, p = 0.002). Integrated TOx for 0-48 h was higher in patients with poor outcome than in patients with good outcome (0.89 95% CI [- 1.17 to 2.94] vs. - 2.71 95% CI [- 4.16 to - 1.26], p = 0.05). Patients with poor outcomes had a decreased upper MAP bound of CVR over time (p = 0.001), including the high-normal oxygen (p = 0.002), carbon dioxide (p = 0.012) and MAP (p = 0.001) groups. The MAP range of maintained CVR was narrower in all time intervals and intervention groups (p < 0.05). NfL concentrations were higher in patients with impaired CVR compared to those with intact CVR (43 IQR [15-650] vs 20 IQR [13-199] pg/ml, p = 0.042). CONCLUSION Impaired CVR over 48 h was more common in patients with chronic hypertension and associated with poor outcome. Decreased upper MAP bound and a narrower MAP range for maintained CVR were associated with poor outcome and more severe brain injury assessed with NfL. Trial registration ClinicalTrials.gov, NCT02698917 .
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Affiliation(s)
- Johanna Laurikkala
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Meilahden SairaalaHaartmaninkatu 4, 000290, Helsinki, Finland.
| | - Anders Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Alexander Peng
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Paul Pham
- Dept of Anaesthesia, John Hunter Hospital, Newcastle, NSW, Australia
| | - Pekka Jakkula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Meilahden SairaalaHaartmaninkatu 4, 000290, Helsinki, Finland
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Meilahden SairaalaHaartmaninkatu 4, 000290, Helsinki, Finland
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Meilahden SairaalaHaartmaninkatu 4, 000290, Helsinki, Finland
| | - Pekka Loisa
- Department of Intensive Care, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jussi Toppila
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,DUK Dementia Research Institute at UCL, London, UK.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Nissilä E, Hynninen M, Reinikainen M, Bendel S, Suojaranta R, Korhonen A, Suvela M, Loisa P, Kaminski T, Hästbacka J. Prevalence and impact of hazardous alcohol use in intensive care cohort: A multicenter, register-based study. Acta Anaesthesiol Scand 2021; 65:1073-1078. [PMID: 33840090 DOI: 10.1111/aas.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/12/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports of the prevalence and impact of hazardous alcohol use among intensive care unit (ICU) patients are contradictory. We aimed to study the prevalence of hazardous alcohol use among ICU patients and its association with ICU length of stay (LOS) and mortality. METHODS Finnish ICUs have been using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) to evaluate and record patients' alcohol use into the Finnish Intensive Care Consortium's Database (FICC). We retrieved data from the FICC from a 3-month period. We excluded data from centers with an AUDIT-C recording rate of less than 70% of admissions. We defined hazardous alcohol use as a score of 5 or more for women and 6 or more for men from a maximum score of 12 points. RESULTS Two thousand forty-five patients were treated in the 10 centers with an AUDIT-C recording rate of 70% or higher. AUDIT-C was available for 1576 (77%) patients and indicated hazardous alcohol use for 334 (21%) patients who were more often younger (median age 55 [interquartile range 42-65] vs 67 [57-74] [P < .001]) and male (78.1% vs 61.3% [P < .001]) compared to other patients. We found no difference in LOS or hospital mortality between hazardous and non-hazardous alcohol users. Among the non-abstinent, risk of death within a year increased with increasing AUDIT-C scores adjusted odds ratio 1.077 (95% confidence interval, 1.006-1.152) per point. CONCLUSION The prevalence of hazardous alcohol use in Finnish ICUs was 21%. Patients with hazardous alcohol use were more often younger and male compared with non-hazardous alcohol users.
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Affiliation(s)
- Eliisa Nissilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
| | - Marja Hynninen
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
| | - Raili Suojaranta
- Department of Cardiac Surgery, Heart and Lung Center University of HelsinkiHelsinki University Hospital Helsinki University Hospital Helsinki Finland
| | - Anna‐Maija Korhonen
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
| | - Markku Suvela
- Intensive Care Unit North Karelia Central Hospital Joensuu Finland
| | - Pekka Loisa
- Intensive Care Unit Päijät‐Häme Central Hospital Lahti Finland
| | - Tadeusz Kaminski
- Intensive Care Unit Central Ostrobothnia Central Hospital Kokkola Finland
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine Intensive Care Units University of HelsinkiHelsinki University Hospital Helsinki Finland
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Ameloot K, Jakkula P, Hästbacka J, Reinikainen M, Pettilä V, Loisa P, Tiainen M, Bendel S, Birkelund T, Belmans A, Palmers PJ, Bogaerts E, Lemmens R, De Deyne C, Ferdinande B, Dupont M, Janssens S, Dens J, Skrifvars MB. Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest. J Am Coll Cardiol 2021; 76:812-824. [PMID: 32792079 DOI: 10.1016/j.jacc.2020.06.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with shock after acute myocardial infarction (AMI), the optimal level of pharmacologic support is unknown. Whereas higher doses may increase myocardial oxygen consumption and induce arrhythmias, diastolic hypotension may reduce coronary perfusion and increase infarct size. OBJECTIVES This study aimed to determine the optimal mean arterial pressure (MAP) in patients with AMI and shock after cardiac arrest. METHODS This study used patient-level pooled analysis of post-cardiac arrest patients with shock after AMI randomized in the Neuroprotect (Neuroprotective Goal Directed Hemodynamic Optimization in Post-cardiac Arrest Patients; NCT02541591) and COMACARE (Carbon Dioxide, Oxygen and Mean Arterial Pressure After Cardiac Arrest and Resuscitation; NCT02698917) trials who were randomized to MAP 65 mm Hg or MAP 80/85 to 100 mm Hg targets during the first 36 h after admission. The primary endpoint was the area under the 72-h high-sensitivity troponin-T curve. RESULTS Of 235 patients originally randomized, 120 patients had AMI with shock. Patients assigned to the higher MAP target (n = 58) received higher doses of norepinephrine (p = 0.004) and dobutamine (p = 0.01) and reached higher MAPs (86 ± 9 mm Hg vs. 72 ± 10 mm Hg, p < 0.001). Whereas admission hemodynamics and angiographic findings were all well-balanced and revascularization was performed equally effective, the area under the 72-h high-sensitivity troponin-T curve was lower in patients assigned to the higher MAP target (median: 1.14 μg.72 h/l [interquartile range: 0.35 to 2.31 μg.72 h/l] vs. median: 1.56 μg.72 h/l [interquartile range: 0.61 to 4.72 μg. 72 h/l]; p = 0.04). Additional pharmacologic support did not increase the risk of a new cardiac arrest (p = 0.88) or atrial fibrillation (p = 0.94). Survival with good neurologic outcome at 180 days was not different between both groups (64% vs. 53%, odds ratio: 1.55; 95% confidence interval: 0.74 to 3.22). CONCLUSIONS In post-cardiac arrest patients with shock after AMI, targeting MAP between 80/85 and 100 mm Hg with additional use of inotropes and vasopressors was associated with smaller myocardial injury.
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Affiliation(s)
- Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
| | - Pekka Jakkula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Ville Pettilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Loisa
- Department of Intensive Care, Päijät-Häme Central Hospital, Lahti, Finland
| | - Marjaana Tiainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stepani Bendel
- Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Ann Belmans
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Eline Bogaerts
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium; VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium; KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology, and Leuven Brain Institute (LBI), Leuven, Belgium
| | - Cathy De Deyne
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium; Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Stefan Janssens
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - Markus B Skrifvars
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Humaloja J, Skrifvars MB, Raj R, Wilkman E, Pekkarinen PT, Bendel S, Reinikainen M, Litonius E. The Association Between Arterial Oxygen Level and Outcome in Neurocritically Ill Patients is not Affected by Blood Pressure. Neurocrit Care 2021; 34:413-422. [PMID: 33403587 PMCID: PMC8128839 DOI: 10.1007/s12028-020-01178-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
Background In neurocritically ill patients, one early mechanism behind secondary brain injury is low systemic blood pressure resulting in inadequate cerebral perfusion and consequent hypoxia. Intuitively, higher partial pressures of arterial oxygen (PaO2) could be protective in case of inadequate cerebral circulation related to hemodynamic instability. Study purpose We examined whether the association between PaO2 and mortality is different in patients with low compared to normal and high mean arterial pressure (MAP) in patients after various types of brain injury. Methods We screened the Finnish Intensive Care Consortium database for mechanically ventilated adult (≥ 18) brain injury patients treated in several tertiary intensive care units (ICUs) between 2003 and 2013. Admission diagnoses included traumatic brain injury, cardiac arrest, subarachnoid and intracranial hemorrhage, and acute ischemic stroke. The primary exposures of interest were PaO2 (recorded in connection with the lowest measured PaO2/fraction of inspired oxygen ratio) and the lowest MAP, recorded during the first 24 h in the ICU. PaO2 was grouped as follows: hypoxemia (< 8.2 kPa, the lowest 10th percentile), normoxemia (8.2–18.3 kPa), and hyperoxemia (> 18.3 kPa, the highest 10th percentile), and MAP was divided into equally sized tertiles (< 60, 60–68, and > 68 mmHg). The primary outcome was 1-year mortality. We tested the association between hyperoxemia, MAP, and mortality with a multivariable logistic regression model, including the PaO2, MAP, and interaction of PaO2*MAP, adjusting for age, admission diagnosis, premorbid physical performance, vasoactive use, intracranial pressure monitoring use, and disease severity. The relationship between predicted 1-year mortality and PaO2 was visualized with locally weighted scatterplot smoothing curves (Loess) for different MAP levels. Results From a total of 8290 patients, 3912 (47%) were dead at 1 year. PaO2 was not an independent predictor of mortality: the odds ratio (OR) for hyperoxemia was 1.16 (95% CI 0.85–1.59) and for hypoxemia 1.24 (95% CI 0.96–1.61) compared to normoxemia. Higher MAP predicted lower mortality: OR for MAP 60–68 mmHg was 0.73 (95% CI 0.64–0.84) and for MAP > 68 mmHg 0.80 (95% CI 0.69–0.92) compared to MAP < 60 mmHg. The interaction term PaO2*MAP was nonsignificant. In Loess visualization, the relationship between PaO2 and predicted mortality appeared similar in all MAP tertiles. Conclusions During the first 24 h of ICU treatment in mechanically ventilated brain injured patients, the association between PaO2 and mortality was not different in patients with low compared to normal MAP. Supplementary Information The online version of this article (10.1007/s12028-020-01178-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaana Humaloja
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erika Wilkman
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Erik Litonius
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Luostarinen T, Satopää J, Skrifvars MB, Reinikainen M, Bendel S, Curtze S, Sibolt G, Martinez-Majander N, Raj R. Early surgery for superficial supratentorial spontaneous intracerebral hemorrhage: a Finnish Intensive Care Consortium study. Acta Neurochir (Wien) 2020; 162:3153-3160. [PMID: 32601805 PMCID: PMC7593281 DOI: 10.1007/s00701-020-04470-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The benefits of early surgery in cases of superficial supratentorial spontaneous intracerebral hemorrhage (ICH) are unclear. This study aimed to assess the association between early ICH surgery and outcome, as well as the cost-effectiveness of early ICH surgery. METHODS We conducted a retrospective, register-based multicenter study that included all patients who had been treated for supratentorial spontaneous ICH in four tertiary intensive care units in Finland between 2003 and 2013. To be included, patients needed to have experienced supratentorial ICHs that were 10-100 cm3 and located within 10 mm of the cortex. We used a multivariable analysis, adjusting for the severity of the illness and the probability of surgical treatment, to assess the independent association between early ICH surgery (≤ 1 day), 12-month mortality rates, and the probability of survival without permanent disability. In addition, we assessed the cost-effectiveness of ICH surgery by examining the effective cost per 1-year survivor (ECPS) and per independent survivor (ECPIS). RESULTS Of 254 patients, 27% were in the early surgery group. Overall 12-month mortality was 39%, while 29% survived without a permanent disability. According to our multivariable analysis, early ICH surgery was associated with lower 12-month mortality rates (odds ratio [OR] 0.22, 95% confidence intervals [CI] 0.10-0.51), but not with a higher probability of survival without permanent disability (OR 1.23, 95% CI 0.59-2.56). For the early surgical group, the ECPS and ECPIS were €111,409 and €334,227, respectively. For the non-surgical cohort, the ECPS and ECPIS were €76,074 and €141,471, respectively. CONCLUSIONS Early surgery for superficial ICH is associated with a lower 12-month mortality risk but not with a higher probability of survival without a permanent disability. Further, costs were higher and cost-effectiveness was, thus, worse for the early surgical cohort.
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Affiliation(s)
- Teemu Luostarinen
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care, and Pain Medicine, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, PO BOX 266, 00029 HUS, Helsinki, Finland.
| | - Jarno Satopää
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Mikkonen ED, Skrifvars MB, Reinikainen M, Bendel S, Laitio R, Hoppu S, Ala-Kokko T, Karppinen A, Raj R. Psychotropic Medication After Intensive Care Unit-Treated Pediatric Traumatic Brain Injury. Pediatr Neurol 2020; 112:64-70. [PMID: 32916426 DOI: 10.1016/j.pediatrneurol.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our aim was to assess the occurrence and risk factors for psychotropic medication use after pediatric traumatic brain injury treated in the intensive care unit. METHODS We combined data from the Finnish Intensive Care Consortium database, data on reimbursed medications from the Social Insurance Institute, and individual electronic health care data. We analyzed data on children aged five to 17 years treated for traumatic brain injury in intensive care units of four university hospitals in Finland during 2003 to 2013 and being alive six months after injury with no history of psychotropic medication use before traumatic brain injury. RESULTS We identified 248 patients of whom 46 (19%) were prescribed a new psychotropic medication after traumatic brain injury. In multivariable logistic regression, a higher age associated with a higher probability for use of any psychotropic medication. Subgroup analyses showed that higher age associated with an increased risk of antidepressant and antipsychotic use but with a decreased risk of stimulant use. Apart from age, we found no other clinical, radiological, or treatment-related factors that significantly associated with subsequent use of psychotropics. Psychotropic medication was most common (45%) in children aged 12 to 17 years and had moderate disability at six-month follow-up. CONCLUSIONS One fifth of children treated in the intensive care unit for traumatic brain injury were prescribed a new psychotropic medication during a median follow-up of three years and five months. Psychotropic medication was most common among teenagers with moderate post-traumatic disability. The need and use of psychotropics postinjury seem multifactorial and not related to any traumatic brain injury type.
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Affiliation(s)
- Era D Mikkonen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Emergency Care and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Ruut Laitio
- Department of Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Tampere University Hospital, Tampere University, Tampere, Finland; Department of Intensive Care, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Tero Ala-Kokko
- Division of Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland; Medical Research Center Oulu MRC, Research group of Anesthesiology, Surgery and Intensive Care Medicine, University of Oulu, Oulu, Finland
| | - Atte Karppinen
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Mikkonen ED, Skrifvars MB, Reinikainen M, Bendel S, Laitio R, Hoppu S, Ala-Kokko T, Karppinen A, Raj R. One-year costs of intensive care in pediatric patients with traumatic brain injury. J Neurosurg Pediatr 2020; 27:79-86. [PMID: 33065534 DOI: 10.3171/2020.6.peds20189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients. METHODS In this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0-17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4-5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO). RESULTS In total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3-12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326-€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335-€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas. CONCLUSIONS Greater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.
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Affiliation(s)
- Era D Mikkonen
- 1Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden, and University of Helsinki
| | - Markus B Skrifvars
- 2Department of Emergency Care and Services, Helsinki University Hospital, and University of Helsinki
| | - Matti Reinikainen
- 3Department of Anesthesiology and Intensive Care, Kuopio University Hospital, and University of Eastern Finland, Kuopio
| | - Stepani Bendel
- 3Department of Anesthesiology and Intensive Care, Kuopio University Hospital, and University of Eastern Finland, Kuopio
| | - Ruut Laitio
- 4Department of Intensive Care, Turku University Hospital, and University of Turku
| | - Sanna Hoppu
- 5Emergency Medical Services and Department of Intensive Care, Tampere University Hospital, and Tampere University, Tampere
| | - Tero Ala-Kokko
- 6Division of Intensive Care, Medical Research Center Oulu, Oulu University Hospital, Research Group of Anesthesiology, Surgery and Intensive Care Medicine, University of Oulu; and
| | - Atte Karppinen
- 7Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Finland
| | - Rahul Raj
- 7Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Finland
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Young PJ, Bailey M, Bellomo R, Bernard S, Bray J, Jakkula P, Kuisma M, Mackle D, Martin D, Nolan JP, Panwar R, Reinikainen M, Skrifvars MB, Thomas M. Conservative or liberal oxygen therapy in adults after cardiac arrest: An individual-level patient data meta-analysis of randomised controlled trials. Resuscitation 2020; 157:15-22. [PMID: 33058991 DOI: 10.1016/j.resuscitation.2020.09.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
AIM The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. METHODS We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. RESULTS Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of follow-up; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. CONCLUSION Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO REGISTRATION NUMBER CRD42019138931.
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Affiliation(s)
- Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia; Centre for Integrated Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Pekka Jakkula
- Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Finland
| | - Markku Kuisma
- Department of Emergency Medicine, Helsinki University Hospital, Finland
| | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Daniel Martin
- Intensive Care Unit, Royal Free Hospital, London, UK; Peninsula Medical School, University of Plymouth, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Rakshit Panwar
- Intensive Care Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Matti Reinikainen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| | - Matt Thomas
- Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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44
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Adamski J, Weigl W, Lahtinen P, Reinikainen M, Kaminski T, Pietiläinen L, Musialowicz T. Intensive care patient survival after limiting life-sustaining treatment-The FINNEOL* national cohort study. Acta Anaesthesiol Scand 2020; 64:1144-1153. [PMID: 32329052 DOI: 10.1111/aas.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients after treatment restrictions. METHODS This retrospective observational study examined all patients treated in adult ICUs from 1 January 2016 until 31 December 2016 included in the Finnish ICU Registry. Multivariable logistic regression analysis was performed to explain the effect on survival. RESULTS Decisions to limit LST were made for 2444 patients (13.7%; 95% CI 13.2-14.2). ICU, hospital, and 12-month survival rates were 71% (95% CI 69-73), 49% (95% CI 47-51), and 24% (95% CI 22-26), respectively. In patients for whom life support was withheld, increased 12-month survival rates were associated with admission from the operating theatre (OR 1.9, 95% CI 1.1-3.4), good pre-hospital physical fitness (OR 4.7, 95% Cl 1.2-16.8) and being housed at home (OR 2.0, 95% Cl 1.4-2.8). Decreased survival rates were associated with admission from a hospital ward (OR 0.67, 95% Cl 0.5-0.9), higher comorbidity (OR 0.6, 95% Cl 0.4-0.9), cancer (OR 0.4, 95%CI 0.2-0.9), greater illness severity (SAPS II; OR 0.98, 95% Cl 0.98-0.99), and higher care intensity (TISS-76; OR 0.93, 95% Cl 0.92-0.95). CONCLUSION Survival among ICU patients with limited treatment was higher than expected. Advanced age was not associated with higher mortality, potentially because treatment restrictions may be set more easily for older patients.
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Affiliation(s)
- Jan Adamski
- Department of Intensive Care Medicine Satakunta Central Hospital Pori Finland
| | - Wojciech Weigl
- Anaesthesiology and Intensive Care Department of Surgical Sciences Uppsala University Hospital Uppsala Sweden
| | - Pasi Lahtinen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
- Faculty of Health Sciences School of Medicine Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Tadeusz Kaminski
- Department of Intensive Care Medicine Central Hospital of Middle Ostrobothnia Kokkola Finland
| | - Laura Pietiläinen
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
| | - Tadeusz Musialowicz
- Department of Anaesthesiology and Intensive Care Medicine Kuopio University Hospital Kuopio Finland
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45
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Mikkonen ED, Skrifvars MB, Reinikainen M, Bendel S, Laitio R, Hoppu S, Ala-Kokko T, Karppinen A, Raj R. Posttraumatic epilepsy in intensive care unit-treated pediatric traumatic brain injury patients. Epilepsia 2020; 61:693-701. [PMID: 32221978 DOI: 10.1111/epi.16483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/19/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Posttraumatic epilepsy (PTE) is a well-described complication of traumatic brain injury (TBI). The majority of the available data regarding PTE stem from the adult population. Our aim was to identify the clinical and radiological risk factors associated with PTE in a pediatric TBI population treated in an intensive care unit (ICU). METHODS We used the Finnish Intensive Care Consortium database to identify pediatric (<18 years) TBI patients treated in four academic university hospital ICUs in Finland between 2003 and 2013. Our primary outcome was the development of PTE, defined as the need for oral antiepileptic medication in patients alive at 6 months. We assessed the risk factors associated with PTE using multivariable logistic regression modeling. RESULTS Of the 290 patients included in the study, 59 (20%) developed PTE. Median age was 15 years (interquartile range [IQR] 13-17), and 80% had an admission Glasgow Coma Scale (GCS) score ≤12. Major risk factors for developing PTE were age (adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00-1.16), obliterated suprasellar cisterns (OR 6.53, 95% CI 1.95-21.81), and an admission GCS score of 9-12 in comparison to a GCS score of 13-15 (OR 2.88, 95% CI 1.24-6.69). SIGNIFICANCE We showed that PTE is a common long-term complication after ICU-treated pediatric TBI. Higher age, moderate injury severity, obliterated suprasellar cisterns, seizures during ICU stay, and surgical treatment are associated with an increased risk of PTE. Further studies are needed to identify strategies to decrease the risk of PTE.
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Affiliation(s)
- Era D Mikkonen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital & University of Helsinki, Helsinki, Finland.,Department of Emergency Care and Services, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ruut Laitio
- Department of Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Department of Intensive Care, Tampere University Hospital & Tampere University, Tampere, Finland
| | - Tero Ala-Kokko
- Division of Intensive Care, Medical Research Center Oulu MRC, Oulu University Hospital, Research Group of Anesthesiology, Surgery and Intensive Care Medicine, University of Oulu, Oulu, Finland
| | - Atte Karppinen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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46
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Aakko-Saksa PT, Vehkamäki M, Kemell M, Keskiväli L, Simell P, Reinikainen M, Tapper U, Repo T. Hydrogen release from liquid organic hydrogen carriers catalysed by platinum on rutile-anatase structured titania. Chem Commun (Camb) 2020; 56:1657-1660. [PMID: 31939461 DOI: 10.1039/c9cc09715e] [Citation(s) in RCA: 22] [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] [Indexed: 12/25/2022]
Abstract
A liquid organic hydrogen carrier (LOHC) is an interesting concept for hydrogen storage. We describe herein a new, active catalyst system for dehydrogenation of perhydrogenated dibenzyl toluene (H18-DBT), which is a promising LOHC candidate. Pt supported on a rutile-anatase form of titania was found to be more active than Pt supported on anatase-only titania, or on alumina, and almost equally active as Pt supported on carbon. Robust and durable metal oxide supports are preferred for catalysing reactions at high temperatures.
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Affiliation(s)
- P T Aakko-Saksa
- University of Helsinki, A. I. Virtasen aukio 1, PO Box 55, 00014 Helsinki, Finland. and VTT Technical Research Centre of Finland Ltd, PO Box 1000, 02044 VTT, Finland.
| | - M Vehkamäki
- University of Helsinki, A. I. Virtasen aukio 1, PO Box 55, 00014 Helsinki, Finland.
| | - M Kemell
- University of Helsinki, A. I. Virtasen aukio 1, PO Box 55, 00014 Helsinki, Finland.
| | - L Keskiväli
- VTT Technical Research Centre of Finland Ltd, PO Box 1000, 02044 VTT, Finland.
| | - P Simell
- VTT Technical Research Centre of Finland Ltd, PO Box 1000, 02044 VTT, Finland.
| | - M Reinikainen
- VTT Technical Research Centre of Finland Ltd, PO Box 1000, 02044 VTT, Finland.
| | - U Tapper
- VTT Technical Research Centre of Finland Ltd, PO Box 1000, 02044 VTT, Finland.
| | - T Repo
- University of Helsinki, A. I. Virtasen aukio 1, PO Box 55, 00014 Helsinki, Finland.
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47
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Kälviäinen R, Reinikainen M. Management of prolonged epileptic seizures and status epilepticus in palliative care patients. Epilepsy Behav 2019; 101:106288. [PMID: 31133511 DOI: 10.1016/j.yebeh.2019.04.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Prolonged seizures and status epilepticus (SE) are relevant problems in palliative care. Timely recognition and effective early treatment with first- and second-line antiepileptic drugs (AEDs) may prevent unnecessary hospitalizations. Seizures should be recognized and addressed like any other symptom that causes discomfort or reduces quality of life. Use of alternative AED administration routes (buccal, intranasal, or subcutaneous) may offer possibilities for effective and individualized AED therapy, even during the last days of life. In hospice or home care, however, also intravenous treatment is possible via vascular access devices for long-term use. Aggressive unlimited intensive care unit (ICU) treatment of refractory SE in palliative patients is mostly not indicated. At worst, intensive care can be futile and possibly harmful: death in the ICU is often preceded by long and aggressive treatments. Metastatic cancer, old age, high severity of acute illness, overall frailty, poor functional status before hospital admission, and the presence of severe comorbidities all increase the probability of poor outcome of intensive care. When several of these factors are present, consideration of withholding intensive care may be in the patient's best interests. Anticipated outcomes influence patients' preferences. A majority of patients with a limited life expectancy because of an incurable disease would not want aggressive treatment, if the anticipated outcome was survival but with severe functional impairment. Doctors' perceptions about their patients' wishes are often incorrect, and therefore, advance care planning including seizure management should be done early in the course of the disease. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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Affiliation(s)
- Reetta Kälviäinen
- Epilepsy Center, Neurocenter, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Matti Reinikainen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
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48
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Aneman A, Laurikalla J, Pham P, Wilkman E, Jakkula P, Reinikainen M, Toppila J, Skrifvars MB. Cerebrovascular autoregulation following cardiac arrest: Protocol for a post hoc analysis of the randomised COMACARE pilot trial. Acta Anaesthesiol Scand 2019; 63:1272-1277. [PMID: 31282566 DOI: 10.1111/aas.13435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Approximately two-thirds of the mortality following out of hospital cardiac arrest is related to devastating neurological injury. Previous small cohort studies have reported an impaired cerebrovascular autoregulation following cardiac arrest, but no studies have assessed the impact of differences in oxygen and carbon dioxide tensions in addition to mean arterial pressure management. METHODS This is a protocol and statistical analysis plan to assess the correlation between changes in cerebral tissue oxygenation and arterial pressure as measure of cerebrovascular autoregulation, the tissue oxygenation index, in patients following out of hospital cardiac arrest and in healthy volunteers. The COMACARE study included 120 comatose survivors of out of hospital cardiac arrest admitted to ICU and managed with low-normal or high-normal targets for mean arterial pressure, arterial oxygen and carbon dioxide partial pressures. In addition, 102 healthy volunteers have been investigated as a reference group for the tissue oxygenation index. In both cohorts, the cerebral tissue oxygenation was measured by near infrared spectroscopy. CONCLUSIONS Cerebrovascular autoregulation is critical to maintain homoeostatic brain perfusion. This study of changes in autoregulation following out of hospital cardiac arrest over the first 48 hours, as compared to data from healthy volunteers, will generate important physiological information that may guide the rationale and design of interventional studies.
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Affiliation(s)
- Anders Aneman
- Intensive Care Unit Liverpool Hospital, South Western Sydney Local Health District Liverpool BC New South Wales Australia
- Faculty of Medicine The University of New South Wales Sydney New South Wales Australia
- Faculty of Medicine and Health Sciences Macquarie University Sydney New South Wales Australia
| | - Johanna Laurikalla
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Paul Pham
- Intensive Care Unit John Hunter Hospital NewcastleNew South Wales Australia
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Pekka Jakkula
- Department of Anaesthesiology, Intensive Care and Pain Medicine University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Matti Reinikainen
- Department NSW of Anaesthesiology and Intensive Care University of Eastern Finland and Kuopio University Hospital Kuopio Finland
| | - Jussi Toppila
- Clinical Neurophysiology HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services University of Helsinki and Helsinki University Hospital Helsinki Finland
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Genoud G, Lehmuskoski J, Bell S, Palonen V, Oinonen M, Koskinen-Soivi ML, Reinikainen M. Laser Spectroscopy for Monitoring of Radiocarbon in Atmospheric Samples. Anal Chem 2019; 91:12315-12320. [PMID: 31500419 PMCID: PMC7076718 DOI: 10.1021/acs.analchem.9b02496] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
![]()
In-situ
monitoring of radiocarbon emissions is challenging due
to the lack of a suitable method for sensitive online detection of
this isotope. Here we report on a complete system for automatized
continuous on-site monitoring of radiocarbon gaseous emissions from
nuclear facilities. By combining radiocarbon detection using mid-infrared
cavity ring-down spectroscopy and an advanced sampling system, an
elevated amount of radiocarbon in an atmospheric-like gas matrix was
detected. Radiocarbon was detected in the form of 14CO2 after extraction of the carbon dioxide from the air sample.
The system is also able to discriminate between radiocarbon in organic
or inorganic molecular form by converting 14CH4 into 14CO2. This work lays the groundwork
for further use of this technology in nuclear facilities for online
on-site monitoring of radioactive gaseous emissions as well as future
work on in-situ monitoring of atmospheric radiocarbon.
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Affiliation(s)
- Guillaume Genoud
- VTT Technical Research Centre of Finland Limited , Espoo FI-02044 VTT , Finland
| | | | - Steven Bell
- National Physical Laboratory , Hampton Road, Teddington , Middlesex TW11 0LW , United Kingdom
| | | | | | | | - Matti Reinikainen
- VTT Technical Research Centre of Finland Limited , Espoo FI-02044 VTT , Finland
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50
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Abstract
Background and Purpose- We compared clinical and radiological predictors of long-term mortality in patients with spontaneous intracerebral hemorrhage (ICH) needing intensive care. Methods- A retrospective multicenter study of adult ICH patients treated in Finnish tertiary hospital's intensive care units during 2003 to 2013. We created 3 multivariable models (clinical, radiological, and combined clinical-radiological) for 12-month mortality prediction and compared their areas under receiver operating characteristic curves (AUCs). We analyzed supratentorial and infratentorial ICHs separately. Results- Of 972 patients (796 supratentorial ICH, 176 infratentorial ICH) included, 43% died within 12 months (42% supratentorial ICH, 49% infratentorial ICH). For all patients, the clinical model (AUC, 0.83; 95% CI, 0.81-0.86) outperformed the radiological model (AUC, 0.73; 95% CI, 0.70-0.77; P<0.001), yet the combined model (AUC, 0.85; 95% CI, 0.83-0.88) outperformed both condensed models (P<0.001). For supratentorial ICH, the combined model outperformed both the clinical and radiological models (AUC, 0.84; 95% CI, 0.81-0.87 versus AUC, 0.82; 95% CI, 0.79-0.85 and AUC, 0.73; 95% CI, 0.69-0.77; P<0.001 for all). For infratentorial ICH patients, the combined model significantly outperformed the radiological model but not the clinical model (AUC, 0.92; 95% CI, 0.88-0.96 versus AUC, 0.76; 95% CI, 0.69-0.83 versus AUC, 0.91; 95% CI, 0.87-0.95; P<0.001 and P=0.433, respectively). Conclusions- Clinical factors were more important than objective radiological factors for 12-month mortality prediction in intensive care unit-treated ICH patients. The effect of clinical and radiological factors on outcome was different for supratentorial and infratentorial ICHs stressing that these should not be treated as one entity.
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Affiliation(s)
- Marika Fallenius
- From the Department of Anesthesiology and Intensive Care (M.F., M.B.S.), Helsinki University Hospital, University of Helsinki, Finland
| | - Markus B Skrifvars
- From the Department of Anesthesiology and Intensive Care (M.F., M.B.S.), Helsinki University Hospital, University of Helsinki, Finland.,Department of Emergency Care and Services (M.B.S.), Helsinki University Hospital, University of Helsinki, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland (M.R., S.B.)
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland (M.R., S.B.)
| | - Sami Curtze
- Department of Neurology (S.C., G.S., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology (S.C., G.S., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland
| | - Nicolas Martinez-Majander
- Department of Neurology (S.C., G.S., N.M.-M.), Helsinki University Hospital, University of Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery (R.R.), Helsinki University Hospital, University of Helsinki, Finland
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