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Biomedical subjects

L Berggren

Publications and source records attributed to L Berggren.

At least 19 recordsLinked to original sources
PubMed2004

Survey of routines for sedation of patients on controlled ventilation in Nordic intensive care units.

BACKGROUND: Sedation strategies and practice for patients on controlled ventilation is variable from place to place as well as over time. Less sedation results in shorter ventilation time and new ventilatory modes permit more awake patients. Previous works estimated sedative and analgesic use in Nordic ICUs some years ago, but current practice is not known. We therefore designed this study to describe pharmacological and practical routines for sedation of patients on controlled ventilation. MATERIAL AND METHODS: We used an electronic questionnaire about characteristics of the participating ICUs and the routines for sedation of ventilator-treated patients, and secondly, an Internet-based 5-day registration on the use of drugs for sedation and analgesia. RESULTS: Eighty-eight of 220 ICUs (36%) responded to the questionnaire and 47 out of these 88 units (53%) used a sedation scale. Written guidelines for sedation were used in 41% of the units. Both daily interruption of sedation infusions and guidelines for weaning from the ventilator were used in 15% of the units. Data on 202 patients (633 patient days) from 55 ICUs were reported. Among analgesics, fentanyl predominated (240/633 days), followed by ketobemidon (160/633 days) and morphine (115/633 days). Propofol and midazolam were the most commonly used agents for sedation (345 and 238/633 days, respectively). CONCLUSION: Most units used a sedation scale, although other strategies to reduce the sedation level had not yet been fully introduced. Differences in pharmacological strategies were found between the Nordic countries, and some favourite drugs could be identified.

APACHE↗
PubMed2004

Intrathecal and oral clonidine as prophylaxis for postoperative alcohol withdrawal syndrome: a randomized double-blinded study.

UNLABELLED: In this study, we evaluated the effect of intrathecal and oral clonidine as supplements to spinal anesthesia with lidocaine in patients at risk of postoperative alcohol withdrawal syndrome (AWS). We hypothesized that clonidine would have a prophylactic effect on postoperative AWS. Forty-five alcohol-dependent patients (daily ethanol intake >60 g) scheduled for transurethral resection of the prostate were double-blindly randomized into three groups. All patients received hyperbaric lidocaine 100 mg intrathecally. The diazepam group (DiazG) was premedicated with diazepam 10 mg orally; the intrathecal clonidine group (Clon(i/t)G) received a placebo (saline) tablet and clonidine 150 microg intrathecally; and the oral clonidine group (Clon(p/o)G) received clonidine 150 microg orally. For patients diagnosed with AWS, the Clinical Institute Withdrawal Assessment for Alcohol, revised scale, was used. Twelve patients in the DiazG had symptoms of AWS, compared with two in the Clon(i/t)G and one in the Clon(p/o)G. The median Clinical Institute Withdrawal Assessment for Alcohol, revised scale, score was 12 in the DiazG versus 1 in the clonidine-treated groups. Two patients in the DiazG had severe delirium. Patients receiving oral clonidine had a slightly decreased mean arterial blood pressure 6-12 h after spinal anesthesia (P < 0.05); patients in the DiazG had a hyperdynamic circulatory reaction 24-72 h after surgery. In conclusion, preoperative clonidine 150 microg, intrathecally or orally, prevented significant postoperative AWS in ethanol-dependent patients. IMPLICATIONS: In this randomized, double-blinded study, clonidine 150 microg both intrathecally and orally prevented postoperative alcohol-withdrawal symptoms in alcohol-dependent men. The effect was superior to that with a single dose of diazepam 10 mg orally.

Administration, Oral↗
PubMed2001

A systematic review of the peripheral analgesic effects of intraarticular morphine.

The analgesic effects of intraarticular morphine are controversial. To systematically evaluate the effects, we performed a review of the literature and a metaanalysis of the peripheral effects of morphine injected intraarticularly. Research databases were searched to identify articles in which peripheral analgesic effects of morphine were studied in patients undergoing arthroscopic knee procedures under local, regional, or general anesthesia. The review was performed on three issues: does morphine injected intraarticularly produce analgesia, is it a dose-dependent effect, and, if so, is the effect systemic or mediated via peripheral opioid receptors? Visual analog score (VAS) and analgesic consumption were studied during the early phase (0-2 h), intermediate phase (2-6 h), and late phase (6-24 h) postoperatively after injection of morphine intraarticularly. Metaanalysis of these effect variables was performed by the weighted-analysis technique, and the essential homogeneity assumption was tested by the chi(2) test. Forty-five articles could be identified in which the effects of morphine were studied in a prospective, randomized manner, and 32 of these studies included a placebo control. Pooled analyses of data from 19 studies suitable for metaanalysis showed an improvement in analgesia after morphine compared with placebo in the order of 12-17 mm on the VAS during all three phases of treatment. Studies with high quality scores showed somewhat smaller improvements. Total analgesic consumption could not be analyzed statistically, but the number of studies showing decreased analgesic consumption or no differences between groups was identical (six and six). No clear dose-response effect was seen when VAS was used as a measure of pain, but it was seen when area under the curve was used as a measure of pain. A systemic effect of peripherally-injected morphine was not possible to exclude because of the very limited data available. We conclude from this metaanalysis that intraarticularly administered morphine has a definite but mild analgesic effect. It may be dose dependent, and a systemic effect cannot be completely excluded.

Analgesics, Opioid↗
PubMed2001

[Studies of vision by Leonardo da Vinci].

Leonardo was an advocate of the intromission theory of vision. Light rays from the object to the eye caused visual perceptions which were transported to the brain ventricles via a hollow optic nerve. Leonardo introduced wax injections to explore the ventricular system. Perceptions were assumed to go to the "senso comune" in the middle (3rd) ventricle, also the seat of the soul. The processing station "imprensiva" in the anterior lateral horns together with memory "memoria" in th posterior (4th) ventricle integrated the visual perceptions to visual experience. - Leonardo's sketches with circular lenses in the center of the eye reveal that his dependence on medieval optics prevailed over anatomical observations. Drawings of the anatomy of the sectioned eye are missing although Leonardo had invented a new embedding technique. In order to dissect the eye without spilling its contents, the eye was first boiled in egg white and then cut. The procedure was now repeated and showed that the ovoid lens after boiling had become spherical. - Leonardo described that light rays were refracted and reflected in the eye but his imperfect anatomy prevented a development of physiological optics. He was, however, the first to compare the eye with a pin-hole camera (camera obscura). Leonardo's drawings of the inverted pictures on the back wall of a camera obscura inspired to its use as an instrument for artistic practice. The camera obscura was for centuries a model for explaining human vision.

Eye↗
PubMed1999

Withdrawal of life support--who should decide? Differences in attitudes among the general public, nurses and physicians.

OBJECTIVE: To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. DESIGN: Nationwide postal questionnaire survey. SETTING: Sweden. PARTICIPANTS: One thousand one hundred ninety-six randomly selected persons from the Swedish population register, 339 nurses and 121 physicians from 29 randomly selected intensive care units (ICUs). MEASUREMENTS AND RESULTS: Respondents' answers to questions related to two clinical scenarios: one with a conscious and competent patient and one with an unconscious patient. The response rates were 64 % for the general public, 86 % for the nurses and 88 % for the physicians. Concerning the competent patient, 48 % of the public, 31 % of the nurses and 8 % of the physicians were of the opinion that a decision about continued ventilator treatment should be made by the patient alone or together with the family, but without the physician. The vast majority of physicians (87 %) wanted to make the decision themselves, either alone or together with the patient or family. Concerning the incompetent patient, 73 % of the general public and 70 % of the nurses advocated a joint decision made by the family and the physician together. The majority of the physicians (61 %) regarded themselves as the sole decision-maker, a view supported by only 5 % of the public and 20 % of the nurses. CONCLUSIONS: While existing Swedish guidelines recommend that the physician should be the sole decision-maker, the general public favour more patient and family influence on the decision to withdraw life support as compared with intensive care physicians.

Adult↗
PubMed1999

Attitudes of Swedish physicians and nurses towards the use of life-sustaining treatment.

BACKGROUND: Withdrawal or withholding of life-sustaining treatment have become accepted clinical practice within the intensive care unit (ICU). One important factor influencing these decisions is the attitudes of physicians and nurses. METHOD: Questionnaire survey of physicians and nurses in ICUs in 12 Swedish university-affiliated and/or tertiary referral hospitals. RESULTS: The response rate was 850 of 1081 (79%) potentially eligible health care workers. Respondents first rated the importance of 16 factors considered in the decision to withdraw life support. The most important factors were the patient's likelihood of surviving the current episode, patient advance directives, patient age and likelihood of long-time survival. Respondents also chose between five levels of care, ranging from comfort measures to full intensive care, in two of 12 different scenarios. Respondent characteristics affecting the level of care chosen were the number of years of ICU experience and the particular ICU in which the respondent worked. CONCLUSION: Advance directives are believed by Swedish intensive care personnel to be very important in the decision to withdraw life support, contrary to several descriptive studies suggesting modest patient and family influence on these decisions. Attitudes towards the intensity of care vary between different centers, raising the possibility that levels of care for similar patients may differ across the country.

Attitude of Health Personnel↗
PubMed1999

Should the ventilator be withdrawn? Attitudes of the general public, nurses and physicians.

In a Swedish nation-wide study, 1196 members of the general public, and 121 physicians and 339 nurses drawn from 29 intensive care units were questioned about the use of ventilator treatment for severely ill patients. Response rates were 64%, 88% and 86%, respectively. Two typical case history scenarios were presented: one describing a conscious and competent patient with pneumonia and severe cancer, and the other describing a patient who had been comatose for 1 month following head trauma. In the case of the cancer patient, 49% of the general public, 63% of the physicians and 59% of the nurses answered that they would wish that the ventilator treatment be discontinued, if they were the patient. In the case of the comatose patient, 48% of the general public, 82% of the physicians and 70% of the nurses answered that they would wish that the ventilator treatment to be discontinued, if they were a relative of the patient. Respondents own preferences, in the three groups, for life support favoured withdrawal of ventilator treatment.

Adult↗
PubMed1998

Limiting life support. Experiences with a special protocol.

BACKGROUND: Different aspects of withholding or withdrawal of life-sustaining treatment have been described in the literature. However, there are few descriptions of local policies or protocols regarding the limiting of life support. The present study describes the pattern of limiting life support in a Scandinavian intensive care unit (ICU) and the experience with a special protocol for such decisions. METHOD: Prospective study of decisions to limit life support in the ICU of a tertiary referral hospital during 1 year using a special protocol and medical records. RESULTS: A decision to limit life support was documented in the special protocol in 61/1008 (6%) of the patients and in 39/79 (49%) of the patients dying in the ICU. Poor prognosis and failure to respond to treatment were the most common reasons for foregoing life-sustaining treatment. Of the 61 patients with a special protocol, 7 survived more than 3 months. The decision was altered for 5 patients towards additional limitations and for 4 patients towards fewer or no limitations. CONCLUSION: Decisions to limit life support in the ICU are common. There is a substantial survival rate. A structured clinical protocol can be used for continuous follow-up of decisions and the decision-making process.

Adolescent↗
PubMed1998

Pulmonary function in adult survivors of severe acute lung injury treated with inhaled nitric oxide.

BACKGROUND: Following an episode of acute respiratory distress syndrome (ARDS), some degree of measurable pulmonary impairment may be anticipated. ARDS is thought to be the more severe form of acute lung injury (ALI) and a recently proposed addition to conventional therapy in ALI/ARDS is inhaled nitric oxide (INO). We carried out a non-randomised follow-up study with pulmonary function tests on survivors of severe ALI/ARDS treated with INO. METHODS: Sixteen previously healthy pulmonary patients, survivors of severe ALI/ARDS, were evaluated with pulmonary function tests >8 months after the acute event. The tests included static and dynamic spirometry, diffusion capacity for carbon monoxide (DLCO), blood gas analysis and evaluation of a chest radiograph. RESULTS: The most common abnormality seen was a low DLCO in 69% of the patients. Abnormally low values were seen in forced vital capacity in 31%, in forced expiratory volume in 1 s in 13%, and in residual volume and total lung capacity in 6%. Blood gas data were within normal limits in 15/16 patients. All chest radiographs showed resolution of the interstitial and alveolar changes present during the acute event. CONCLUSION: In this non-randomised follow-up study we conclude that a degree of measurable pulmonary impairment after INO treatment in severe ALI/ARDS was common, but did not differ markedly from other published studies on pulmonary function in similar patient material. No late unexpected major abnormalities due to the inhaled nitric oxide treatment could be identified in these survivors.

Administration, Inhalation↗
PubMed1997

A retrospective analysis of nitric oxide inhalation in patients with severe acute lung injury in Sweden and Norway 1991-1994.

BACKGROUND: Patients with severe acute lung injury (ALI) have been treated compassionately on doctors' initiative with inhaled nitric oxide (INO) in Sweden and Norway since 1991. In 1994 the previously used technical grade nitric oxide was replaced by medical grade nitric oxide. METHODS: We have carried out a retrospective data collection on all identified adult patients treated with INO for >4 h during the period 1991-1994 focusing on safety aspects and patient outcome. We used the following exclusion criteria (1) Age <18 years, (2) Simultaneous treatment with extracorporeal removal of CO2 (3) NO inhalation period <4 h, (4) Incomplete or missing patient charts, (5) Use of INO in order to treat pulmonary hypertension following cardiac surgery, with little or no acute lung injury. RESULTS: Inclusion criteria were met by 56 out of 73 identified patients. Mean age was 48+/-19 years and the median duration of INO treatment was 102 h. PaO2/FIO2 ratio at start of treatment was 85 +/- 33 mm Hg with a lung injury score (LIS) of 3.2+/-0.8. The aetiology of the lung injury was pneumonia (n= 27), sepsis (n=12) and trauma (n=8). Survival to hospital discharge was 41% and survival after 180 d was 38%. Three serious adverse events were identified, two from technical failures of the INO delivery device and one withdrawal reaction necessitating slow weaning from INO. No methaemoglobin values >5% were reported during treatment. CONCLUSION: The overall mortality did not differ dramatically from historical controls with high mortality. Only a randomised study may determine whether INO as an adjunct to treatment alters the outcome in severe ALI. One cannot at present advocate the routine use of INO in patients with ALI outside such studies.

Administration, Inhalation↗
PubMed1997

[Drugs and poisons in the life of Vincent van Gogh].

Van Gogh was during his last years exposed to several potentially toxic substances such as; bromides, lead, camphor and terpene oils in absinthe liquor. All of them produce signs of toxicity which are similar to the symptoms known from van Gogh's attacks of illness; hallucinations, confusion, delirium, convulsions and agitation. However, the many interpretations of van Gogh's illness and state of mind have in most cases not taken into account the possible influence of toxic chemicals.

Belgium↗
PubMed1996

Response to nitric oxide inhalation in early acute lung injury.

OBJECTIVE: To evaluate the dose response of inhaled nitric oxide (NO) on gas exchange and central haemodynamics in patients with early acute lung injury (ALI). DESIGN: Prospective, multicentre clinical study. SETTING: General ICUs in university and regional hospitals. PATIENTS: 18 Patients with early ALI according to specified criteria. INTERVENTIONS: During controlled ventilation an inhalation system was used to deliver NO (1000 ppm in N2) and O2/air to the low pressure fresh gas inlet of a Siemens 900C ventilator. Haemodynamics and pulmonary gas exchange variables were measured at baseline and at stepwise increased inspiratory NO concentrations of 0.1, 0.3, 1, 3, 10, 30 and 100 ppm, each dose being maintained for 15 min. Dose testing was repeated the next day, and the response to prolonged (2 h) NO inhalation at 1 and 10 ppm was also tested. MEASUREMENTS AND RESULTS: Inhalation of NO produced a significant increase in PaO2 (P < 0.0025). The degree of response, as well as the optimal NO dose varied in individual patients and between different days. Venous admixture (QVA/QT) was reduced (P < 0.02) from 38% (31-46%) to 33% (26-41%). In our patients with early acute lung injury and only a moderate elevation in pulmonary arterial pressure NO inhalation did not reduce mean pulmonary artery pressure significantly, being 27.0 (21-30) mmHg at baseline and 26.0 (21-30) mm Hg at 100 ppm. CONCLUSIONS: This study shows that improvements in arterial oxygenation in response to inhaled NO may show great inter- as well as intraindividual variability, and that improvements in arterial oxygenation occur without any measurable lowering of the pulmonary artery pressure.

Administration, Inhalation↗