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M Tallgren

Publications and source records attributed to M Tallgren.

13 recordsLinked to original sources
PubMed2006

Quality assessment of sedation in intensive care.

BACKGROUND: In the intensive care unit (ICU), analgesia and sedation are used to improve the comfort and safety of patients undergoing intensive care therapies. However, continuous administration of sedatives prolongs the time on mechanical ventilation and ICU stay. These adverse effects can be reduced by clear definition of the goals of sedation combined with a sedation protocol. METHODS: The adherence to the local sedation guideline of a university affiliated ICU was monitored prospectively before and after intervention: reinforcement of the guideline. The primary endpoints of the study were the occurrence of daily interruption or tapering of sedation and achievement of the target Ramsay scale level (days: 2-3, nights: 3-4) according to the guideline. RESULTS: Comparing sedation before and after the intervention (166 and 170 ICU days), no significant differences were observed in the occurrence of daily interruption or tapering of sedatives, 94/129 (73%) vs. 109/139 (78%) of sedation days, nor in the Ramsay scale level during the day, 4 (3-5) vs. 4 (3-5), or in the night, 5 (4-5) vs. 5 (4-5), respectively. After the intervention, Ramsay scale recordings were made more frequently, 280/398 (70%) vs. 234/380 (62%) of the nurses' shifts (P < 0.01). CONCLUSION: Adherence to the local sedation guideline was not high, and no significant change was seen after this simple intervention. Continuous education and discussion on the desirable and undesirable effects of sedation, followed by multidisciplinary re-evaluation of the current guideline, are due in our unit.

Aged↗
PubMed2005

Ethical issues in intensive care--a survey among Scandinavian intensivists.

BACKGROUND: The general principles of medical ethics are universally accepted. In practice, however, there is variation on how these principles are interpreted by people with different cultural backgrounds. The aim of this study was to document the views of Scandinavian intensive care physicians on intensive care unit (ICU) admission, triage, withholding and withdrawal of intensive care, and communication between the patient, the family and the ICU team. METHODS: A questionnaire was developed and sent to 84 intensive care physicians working in Denmark, Finland, Sweden and Norway. RESULTS: The response rate was 61%. In general, the responses were in agreement with published guidelines. Nevertheless, there was considerable variation on what factors are taken into account when priority decisions are made. In addition, the views on the content of information provided to the family varied. A majority of 80% reported priority decisions being made on a regular basis. Less than one-half of the respondents had correct knowledge regarding the existence or lack of national guidelines on intensive care ethics. Only 8% of the respondents were aware of guidelines published by the Society of Critical Care Medicine. CONCLUSION: Variation in priority determinants between individual physicians may compromise justice in health care. An effort should be made to discuss and adopt mutual principles. In addition, the quality of information available to the patients' representatives deserves our attention. The results of this study could be used as a basis for discussion when guidelines on the ethical aspects of intensive care are developed and reviewed.

Adult↗
PubMed2004

Predictive value of interleukins 6, 8 and 10, and low HLA-DR expression in acute renal failure.

AIMS: HLA-DR expression and plasma levels of pro- and anti-inflammatory cytokines (IL-6, IL-8 and IL-10) and their predictive value concerning survival of critically ill systemic inflammatory response syndrome (SIRS) patients with and without acute renal failure (ARF) were evaluated. MATERIAL: A total of 103 consecutive adult patients with SIRS from 2 university hospital intensive care units participated in the study. METHOD: Laboratory data for all patients were prospectively collected on the day of admission and 2 days thereafter. Patients with acute renal failure (ARF) and non-ARF patients were compared by Mann-Whitney U-test. Independent predictors of mortality were tested using forward stepwise logistic multiple regression analysis. The discriminative power of different variables was tested using receiver operating characteristic (ROC) curve analysis. RESULTS: ARF developed in 36 patients (35%). ARF patients showed significantly lower HLA-DR expression and higher plasma levels of IL-6, IL-8 and IL-10 than non-ARF patients. In ARF, moderate discriminative power in predicting survival was observed for day 2 IL-6 and IL-10 plasma levels (AUCs 0.703 and 0.749, respectively). CONCLUSIONS: We found no clinically significant discriminative power in predicting survival of ARF patients for monocyte HLA-DR expression or cytokine plasma levels. Therefore, our results do not support the use of HLA-DR expression or cytokine plasma levels for that purpose.

Acute Kidney Injury↗
PubMed2004

Evolution and predictive power of serum cystatin C in acute renal failure.

AIMS: The serum concentration of cystatin C has recently been proposed as a better indicator of glomerular filtration rate (GFR) than plasma creatinine. Little is known about cystatin C in critical illness. We assessed serum cystatin C as a marker of renal function in acute renal failure (ARF) and its power in predicting survival of ARF patients. MATERIAL: 202 consecutive adult patients admitted into the intensive care unit (ICU) during a period of 9 months. METHOD: Serum cystatin C, plasma creatinine and plasma urea were measured on admission, daily during the first 3 days, and 5-7 times a week during the rest of the ICU stay. The patients with and without ARF were compared by the Mann-Whitney U-test. The correlation between different variables was calculated by Spearman's correlation. Forward stepwise multiple regression analysis was performed to test independent predictors of mortality. The positive predictive value of serum cystatin C and plasma creatinine for ARF and mortality was calculated by ROC analysis. RESULTS: ARF occurred in 54 patients (27%). Serum cystatin C showed excellent positive predictive value for ARF in critical illness by ROC analysis. In acute renal dysfunction, abnormal values of serum cystatin C and plasma creatinine appeared equally quickly (median 3 days). The diagnosis of ARF, the day 1 Apache II score and admission plasma creatinine appeared as independent predictors of hospital mortality. ROC analysis showed only weak predictive power for serum cystatin C and plasma creatinine regarding hospital mortality. CONCLUSIONS: Serum cystatin C was as good as plasma creatinine in detecting ARF in intensive care patients. Neither marker was clinically useful in predicting mortality.

Acute Kidney Injury↗
PubMed1999

Hepatic and splanchnic oxygenation during liver transplantation.

OBJECTIVE: To evaluate hepatic and splanchnic oxygenation during liver transplantation. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Ten adult patients undergoing liver transplantation. INTERVENTIONS: Standardized surgery and anesthesia without venovenous bypass. MEASUREMENTS AND MAIN RESULTS: Hepatic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in hepatic venous blood. Splanchnic oxygenation was assessed by analyzing oxygen tension, oxygen saturation, and lactate concentration in portal venous blood and by gastric tonometry. Before reperfusion, the grafts were flushed with 1000 mL of acetated Ringer's solution and 400 mL of portal venous blood. The effluent blood from the graft was wasted and showed a mean pH of 6.86 and a lactate concentration of 9.4 mmol/L. Five minutes after portal reperfusion, most of the grafts produced lactate. Portal-hepatic venous P(CO2) difference ranged from 3 to 16 torr (0.4-2.1 kPa). By the time of restoration of the infrahepatic caval flow mean 24 mins later, eight of the grafts had stopped producing lactate. Mean hepatic venous oxygen tension was 47 torr (6.3 kPa), stabilizing to 41 torr (5.5 kPa) at the end of surgery. Acidosis resolved without pharmacologic interventions. Mean gastric mucosal pH was 7.29 during the anhepatic phase and 7.40 at the end of surgery. One of the patients developed hepatic arterial thrombosis intraoperatively. Her data were analyzed separately. Later, the other patients recovered with good liver function, whereas the patient with hepatic arterial thrombosis was successfully retransplanted. CONCLUSIONS: The liver grafts received well-oxygenated portal venous blood during reperfusion, despite the low values of gastric mucosal pH immediately before reperfusion. Hepatic oxygenation became adequate soon after reperfusion. In the patient with hepatic arterial thrombosis, the recovery of hepatic oxygenation was impaired and lactic acidosis persisted.

Adult↗
PubMed1997

Pharmacokinetics and ventilatory effects of oxycodone before and after liver transplantation.

The pharmacokinetics and ventilatory effects of oxycodone were studied in six volunteer patients with end-stage liver cirrhosis before and after orthotopic liver transplantation. Plasma samples and urine were collected for 24 hours after intravenous administration of 0.05 mg/kg oxycodone hydrochloride. Concentrations of oxycodone and its metabolites, noroxycodone and oxymorphone, were measured in plasma and urine. THe median elimination half-life of oxycodone was 13.9 hours (range, 4.6 to 24.4 hours) in patients with cirrhosis before transplantation and 3.4 hours (range, 2.6 to 5.1 hours) after transplantation (p < 0.05). Correspondingly, oxycodone clearance increased from 0.26 L/min (range, 0.15 to 0.73 L/min) before transplantation to 1.13 L/min (range, 0.71 to 3.98 L/min) after transplantation (p < 0.05). Oxycodone depressed ventilation more strongly before transplantation than after transplantation (p < 0.05). Care should be exercised when oxycodone is used in patients with end-stage disease.

Analgesics, Opioid↗
PubMed1996

Respiratory compliance during orthotopic liver transplantation.

After liver transplantation, respiratory complications are frequent. The purpose of this study was to assess if intraoperative monitoring of respiratory compliance is of clinical value in predicting such complications. Respiratory compliance was continuously monitored with a side-stream respiratory gas flow and pressure sensor (Datex, Helsinki, Finland) at the endotracheal tube in 18 adult patients undergoing orthotopic liver transplantation without veno-venous bypass. Respiratory compliance decreased along with blood volume expansion under anaesthesia before the start of surgery (P < 0.05). Compliance improved as ascites was removed at the beginning of laparotomy (P < 0.001). The highest compliance values were seen during liver surgery. In the patients without ascites preoperatively, compliance was lower at the end of surgery than at anaesthesia induction (P < 0.001). In the patients with ascites, compliance at the end of surgery was equally low as at anaesthesia induction. Compliance at the end of surgery was lower in the patients with bilateral than in those with right-sided or no pleural effusions in the postoperative chest X-rays (P < 0.001). In conclusion, intraoperative monitoring of respiratory compliance is one useful method for clinical use in predicting postoperative bilateral pleural effusions.

Anesthesia↗
PubMed1996

Cardiac evaluation of liver transplant recipients: QT dispersion in electrocardiogram.

Increased QT dispersion, the interlead variability of the QT interval length in the 12-lead electrocardiogram, reflects uneven ventricular repolarization as a sign of cardiomyopathy. We analyzed QT dispersion in the preoperative electrocardiogram of 100 adult liver transplant recipients and 20 healthy control subjects. In 12% of the liver recipients, QT dispersion was increased above 65 ms (mean + 3SD). Six of these patients had a liver storage disease (haemochromatosis, Wilson's disease or amyloidosis). Five had a history of cardiac disease. Severe intraoperative cardiac complications occurred in three patients with markedly increased QT dispersion (> or = 99 ms). In conclusion, in liver storage diseases the heart may be affected, leading to increased risk of cardiac complications, which might be predicted from increased QT dispersion. Analysis of QT dispersion, a noninvasive inexpensive technique, can be recommended to be included in the cardiac screening of liver transplant candidates.

Adult↗
PubMed1995

Changes in respiratory compliance at laparoscopy: measurements using side stream spirometry.

In order to quantify changes in total respiratory compliance (Crs) effected by peritoneal pressurization we measured, under standardized anaesthetic conditions and using side stream spirometry Crs in 32 patients scheduled for abdominal surgery through laparoscopic techniques. To qualify the changes in Crs as to the type (duration and patient's position) of surgery, 20 patients having cholecystectomy, eight having gastric fundoplication, and four having inguinal hernia repair were studied. At CO2 insufflation to a mean intraabdominal pressure of 11 cmH2O in the horizontal position, Crs decreased abruptly by 20% in each of the surgical sub-groups (P < 0.05-0.01). During the insufflation period a further deterioration was observed, most pronounced in inguinal hernia patients operated upon in a head-down tilt position (P < 0.05). In the cholecystectomy and fundoplication patients, operated upon in a head-up tilt, the recovery of Crs was immediate at deflation, whereas an incomplete recovery (P < 0.05 vs initial values) was seen in the hernia patients. In evaluating all patients none of the demographic factors, age, sex, body-mass-index, intraabdominal pressure, or duration of pressurization, were associated with the detected changes.

Adult↗
PubMed1991

Low prevalence of hepatitis C antibodies in chronic liver disease in Finland.

High prevalence of hepatitis C antibodies (anti-HCV) have been found in the Middle- and Southern European countries in connection with chronic liver diseases. In a study of Finnish chronic liver disease patients no anti-HCV antibodies were found in 22 autoimmune chronic active hepatitis, in 5 chronic persistent hepatitis and in 38 alcoholic liver disease patients. 2/30 primary biliary cirrhosis patients were anti-HCV positive. As a comparison 3/9 patients with acute community acquired non-A non-B hepatitis and 28/48 i.v. drug addicts had anti-HCV antibodies. The results indicate that HCV infections in Finnish chronic hepatitis patients are rare.

Adult↗
PubMed1988

Diagnosis of cytomegalovirus infection by detection of the early antigen of cytomegalovirus in cell cultures.

Conventional virus isolation and detection of cytomegalovirus (CMV) early antigen by immunofluorescence staining of cultured cells were compared in the diagnosis of CMV infection from urine specimens. By virus isolation, 33 specimens out of 333 studied were positive, and the mean length of culturing time for a positive result was 23 days (range from 6 to 45 days). By early antigen detection, 35 specimens were positive after 20 hours in culture, but the number of positive findings increased to as high as 49 after 7 days in culture. It is recommended that, in addition to the early antigen staining after one day in culture, cells should also be stained after one week in culture, because the sensitivity is essentially improved by extended culturing time.

Antigens, Viral↗