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Biomedical subjects

P Nikki

Publications and source records attributed to P Nikki.

At least 19 recordsLinked to original sources
PubMed1994

Contribution of non-neurologic disturbances in acute physiology to the prediction of intensive care outcome after head injury or non-traumatic intracranial haemorrhage.

OBJECTIVE: To study the additional contribution of non-neurologic disturbances in acute physiology and chronic health to the prediction of intensive care outcome in patients with head injury or non-traumatic intracranial haemorrhage. DESIGN: A nationwide study in Finland with prospectively collected data on all adult patients admitted to intensive care after head trauma or non-traumatic intracranial haemorrhage during a 14-month period. Two-thirds of the patients were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. SETTING: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). PATIENTS: 901 consecutive adult patients with head injury or non-traumatic intracranial haemorrhage. MEASUREMENTS AND RESULTS: Variables of the APACHE II including Glasgow Coma Score were collected at the time of ICU admission. Two predictive models were created to explain hospital mortality. The addition of variables describing acute physiology to a predictive model consisting of Glasgow Coma Score, age, diagnosis of head injury and the type of ICU admission did not increase its performance in discriminating between survivors and nonsurvivors, but the calibration accuracy of the predictive model especially at the high ranges of risk was improved. CONCLUSIONS: The non-neurologic disturbances in acute physiology have prognostic significance in the prediction of intensive care outcome in patients with head injury or non-traumatic intracerebral haemorrhage. The created predictive model may supplement clinical judgement of this patient group.

APACHE↗
PubMed1994

Continuous positive airway pressure by mask in patients after coronary surgery.

Thirty patients who underwent coronary artery bypass grafting were randomized to receive 30% oxygen by mask either with an ambient airway pressure or with 7.4 mmHg (1 kPa) continuous positive airway pressure (CPAP) for 8 h after extubation. Arterial blood oxygen tension (PaO2) decreased remarkably in the control group after extubation (from 19.2 +/- 5.3 kPa to 12.4 +/- 2.7 kPa) but less in the CPAP group (from 16.4 +/- 3.3 kPa to 14.0 +/- 2.1 kPa). On the second postoperative morning PaO2 was equally low in both groups (control: 8.4 +/- 1.5 kPa, CPAP: 8.9 +/- 1.9 kPa). Atelectatic areas were seen with similar frequency in both groups, 17% (whole material) on the first and 50% on the second postoperative morning. Atelectasis was more common in patients with internal thoracic artery grafting and/or pleural drainage. In conclusion, CPAP therapy was well tolerated, and minimized the decrease in PaO2 after extubation, but could not prevent the poor oxygenation or the late development of atelectatic areas on the second postoperative day.

Adult↗
PubMed1994

Prediction of outcome from intensive care after gastroenterologic emergency.

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II-system. The models were constructed by using data from a random two-thirds of the study population and validated in the remaining independent one-third together with the original APACHE II-index. The Acute Physiology Score, age, and a pre-existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II-equation when tested by the goodness-of-fit -statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into account the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.

APACHE↗
PubMed1994

Diaphragmatic movement studied with ultrasound during spontaneous breathing and mechanical ventilation with intermittent positive pressure ventilation (IPPV) and airway pressure release ventilation (APRV) in man.

Earlier knowledge about diaphragmatic movement during mechanical ventilation is based on radiological information. Since real-time bed-side monitoring is now possible the movement of the right hemidiaphragm was studied using ultrasound (US), both during spontaneous and mechanical ventilation. Nine healthy non-medicated volunteers lying supine were exposed to the following ventilation modes in random order: 1. breathing air at ambient pressure, or 2. at 7.6 mmHg of CPAP or 3. mechanical ventilation with airway pressure release ventilation (APRV), or 4. with IPPV, by mask. The movement of the diaphragm was recorded with a US sector transducer, imaging the ventral, dome and dorsal parts. The maximal movement was detected in the dome in four volunteers during spontaneous breathing with both ambient pressure and CPAP, but in the ventral part in seven and six volunteers, respectively, during APRV and IPPV. Diaphragmatic movement can be studied with US and the findings support the earlier study, with the diaphragm shifting towards the non-dependent regions of the lungs during mechanical ventilation. In this respect APRV is similar to IPPV.

Adult↗
PubMed1993

Orbicular muscle akinesia in regional ophthalmic anaesthesia with pH-adjusted bupivacaine: effects of hyaluronidase and epinephrine.

The success rate and duration of lid akinesia after adding hyaluronidase and/or epinephrine to pH-adjusted bupivacaine was examined in a double-blind fashion in patients undergoing cataract surgery under local anaesthesia. A two-injection-site technique was used. For globe akinesia all patients (n = 120) received an inferolateral intraconal injection (3 ml) of pH-adjusted bupivacaine 0.75% and hyaluronidase. Lid akinesia was obtained with a medial extraconal injection (3.5 ml) of alkalinized bupivacaine with or without an adjunct. The patients were randomized to four groups as follows: a medial injection of plain bupivacaine (n = 31), with added hyaluronidase (n = 30), with added epinephrine (n = 29) or with both epinephrine and hyaluronidase (n = 30). The final solutions had a pH of 6.7. Lid akinesia was supplemented with periosteal injections if needed. The degree of akinesia from clinical assessment was graded from 0-2 and also measured with electromyography at ten minute intervals for 30 min after surgery, and three hours after the block. The least satisfactory result (P < 0.01) and shortest duration of the lid block (P < 0.05) was obtained with plain pH-adjusted bupivacaine. No differences in the success rate or duration of the block among the other groups were seen. The duration of the block was longer in the epinephrine groups than in the two other groups (P < 0.01) and longer in the epinephrine and hyaluronidase group than in the group receiving only hyaluronidase (P < 0.05). We conclude that the best initial results and longest duration of blocks were shown in the groups receiving epinephrine or epinephrine and hyaluronidase.

Action Potentials↗
PubMed1992

Hyaluronidase improves regional ophthalmic anaesthesia with etidocaine.

The effect of adding hyaluronidase to regional ophthalmic anaesthesia with etidocaine 1.5% was examined. Two studies were performed in a double-blind fashion. In Study #1, 70 patients were given peribulbar anaesthesia with etidocaine either with or without hyaluronidase (7.5 IU.ml-1) using a standard intraorbital injection and separate lid injections. The block was supplemented as needed. Lower intraorbital volumes (6.4 +/- 2.2 ml vs 8.2 +/- 2.3 ml, P < 0.01) and improved scores for globe akinesia (P < 0.01), lid akinesia (P < 0.01) and analgesia (P < 0.05) were recorded in the hyaluronidase group than in the plain etidocaine group. In Study #2, 80 patients were randomized to receive etidocaine and hyaluronidase either at a concentration of 7.5 IU.ml-1 or 15 IU.ml-1 using a two-injection-site technique. No differences were noted in the volumes of local anaesthetics required or in the success rates between the two groups. It was concluded that the addition of hyaluronidase to etidocaine decreases the volume needed and improves the quality of block compared with plain etidocaine. Doubling the dose of hyaluronidase does not improve the effectiveness of block.

Aged↗
PubMed1992

Ptosis following periocular or general anaesthesia in cataract surgery.

The incidence and duration of postoperative ptosis was investigated in 64 patients undergoing cataract surgery. Thirty-two patients had a 2-point periocular regional anaesthesia while 32 others were given general anaesthesia. The palpebral aperture and the levator muscle function were measured preoperatively and then on the 1st, 2nd, 4th and 7th postoperative days or as long as ptosis persisted. On the 1st postoperative day, about half of the patients in both groups demonstrated ptosis. On the 2nd day, ptosis was more common in the general anaesthesia group. The ptosis persisted 1 week postoperatively in 2 patients, both belonging to the general anaesthesia group. It is concluded that postoperative ptosis is common both after local and general anaesthesia. In most cases it is shortlasting and may be related to the volume or myotoxicity of a local anaesthetic drug. The use of a superior rectus muscle bridle suture and/or lid speculum may be important in provoking ptosis of longer duration.

Aged↗
PubMed1992

Diaphragmatic movement using ultrasound during spontaneous and mechanical ventilation: effect of tidal volume.

Using ultrasound (US) the effect of various tidal volumes on the movement of ventral, dome and dorsal parts of the right hemidiaphragm was studied, both during spontaneous and mechanical ventilation. Six healthy non-medicated volunteers who were in the supine position breathed spontaneously shallowly (tidal volume (VT) being 400 ml) (SB), and deeply (VT 1000 ml) (SB-deep). In addition, they were mechanically ventilated with intermittent positive pressure ventilation at three different VT's: 500 ml (IPPV-500), 1000 ml (IPPV-1000) and 1700 ml (IPPV-1700). The maximal movement was recorded in the ventral part in 2 volunteers during SB, in 3 during SB-deep, and in 3 and 5 subjects during IPPV-500 and IPPV-1700, respectively. The movement in dome was 100% during SB (all others standardized to this), 303 +/- 107% during SB-deep, 82 +/- 30% during IPPV-500, 165 +/- 70% during IPPV-1000 and 266 +/- 153% during IPPV-1700. An increased tidal volume is associated with an increase in the diaphragmatic movement studied by US. However, a larger VT is needed during mechanical ventilation to achieve the same amount of change as occurred with deep spontaneous breathing.

Diaphragm↗
PubMed1992

Comparison of two needle lengths in regional ophthalmic anesthesia with etidocaine and hyaluronidase.

The effect of needle length on the efficacy of regional ophthalmic anesthesia in conjunction with cataract surgery was studied in 97 patients using a two-site injection technique. The local anesthetic used was etidocaine 1.5% with hyaluronidase. In 48 patients, the anesthetic was administered inferolaterally with a 22-millimeter needle, and in the other 49 patients, with a 31-millimeter needle. Every patient had a medial injection with a 12-millimeter needle to achieve lid akinesia and to complete the globe akinesia. At 5 minutes, lid akinesia was considered better in the 22-millimeter needle group (P < .005). After one supplemental dose, when necessary, complete globe akinesia was achieved at 15 minutes significantly more often (94% vs 79%) in the 31-millimeter needle group (P < .05). Lid akinesia in the two groups was identical at that time. Eight patients in the short-needle group and three in the long-needle group experienced some pain during surgery. Throughout the study, the required intraorbital anesthetic volumes were smaller in the 31-millimeter needle group. We recommend the use of a 31-millimeter needle inferolaterally in combination with a 12-millimeter needle medially to achieve satisfactory regional anesthesia for cataract surgery.

Aged↗
PubMed1991

Current practice regarding invasive monitoring in intensive care units in Finland. A nationwide study of the uses of arterial, pulmonary artery and central venous catheters and their effect on outcome. The Finnish Intensive Care Study Group.

As part of a nationwide evaluation of intensive care, we examined patient- and hospital-related factors which could influence the patterns of utilization of arterial cannulae and central venous and pulmonary artery catheters. We also studied the possible impact of these interventions on the short-term outcome among 14,951 consecutive ICU admissions to 25 intensive care units (75% of all ICU beds) in Finland. There was considerable variation between individual units in the use of these devices even if the differences in severity of illness were taken into account. Arterial cannulation was used in 71.2%, PA catheterization in 10.6% and CVP monitoring in 49.3% of cases in teaching ICUs, excluding cardiac surgery, and in 38.5%, 2.6% and 33.1% of cases in non-teaching ICUs respectively. The factors predicting the use of invasive monitoring included extensive surgery causing a risk of cardiovascular instability, needs for mechanical ventilation, infusion of vasoactive drugs and complicated fluid therapy. Cardiovascular problems among non-operative patients increased the odds for PA catheterization but reduced them for arterial and CV cannulation. No clear-cut benefit could be found in the form of hospital mortality reduction from invasive haemodynamic monitoring, used as described in this study.

Catheterization, Central Venous↗
PubMed1991

Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest.

OBJECTIVES: a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction. DESIGN: A nationwide study in Finland with prospectively collected data on all patients admitted to intensive care after cardiac arrest during a 14-month period. Two thirds of the cardiac arrest patients included in the study were randomly selected to derive predictive models, and the remaining one third constituted the validation sample. SETTING: A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers). PATIENTS: Six-hundred nineteen consecutive cardiac arrest patients. Fifteen patients less than 16 yrs were excluded. MAIN OUTCOME MEASURES: Variables included in the APACHE II or Glasgow Coma Scores were collected at the time of ICU admission and then three times after admission, at 24-hr intervals. ICU- and hospital-mortality rates and a 6-month mortality rate after ICU admission were studied. RESULTS: Of 604 study patients, 370 (61.3%) patients died in the hospital. The most accurate prediction of hospital outcome was based on data collected after the first day of ICU care, not on the admission values. Twenty-one (21.9%) of 96 patients with a low APACHE II score (less than or equal to 9) died compared with 66 (84.6%) of 78 patients with a high APACHE II score (greater than or equal to 25) (p less than .001). Of 160 patients with a normal Glasgow Coma Score (14 to 15), 45 (28.1%) died, whereas there were 114 (81.4%) nonsurvivors among 140 patients with a low Glasgow Coma Score of 3 (p less than .001). The performance of predictive models, including age, the Chronic Health Evaluation, and either the Acute Physiology Score (Acute Physiology Score model) or the Glasgow Coma Score (Glasgow Coma Score model) were compared with the prediction according to the APACHE II in the validation sample. When using 80% probability of death as a decision rule, the Acute Physiology Score model determined 35 of 153 patients to have high risk of death, 29 of whom died (the positive predictive value being 82.9%). The Glasgow Coma Score model predicted 34 patients to die, 26 of whom died (positive predictive value 76.5%), and the APACHE II score predicted seven deaths, five of whom actually died (positive predictive value 71.4%). CONCLUSIONS: The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.

Adult↗
PubMed1991

Comparison of retrobulbar and periocular injections of lignocaine by computerised tomography.

Ten patients undergoing cataract surgery were given a local anaesthetic with lignocaine solution which was mixed with iohexol contrast medium. The location of the needle and the substance injected was determined by computerised tomography following retrobulbar or periocular anaesthesia. The retrobulbarly inserted needles were within the muscle cone, directed towards the optic foramen. The periocular needles were outside the muscle cone, tangentially along the orbital floor or pointing slightly upwards. After the retrobulbar injection the contrast medium was seen within the cone immediately after the injection and outside the cone as early as 3 minutes after the injection. With the periocular technique, however, diffusion of the anaesthetic in the opposite direction (that is, into the muscle cone) was rapid. The contrast medium was identified inside the muscle cone 2 minutes after the injection. Compression with an intraocular pressure reduction device after both of these techniques prevented exophthalmos. It is concluded that retrobulbar-like anaesthesia can also be induced by an appropriate periocular technique.

Adult↗
PubMed1990

Nimodipine after resuscitation from out-of-hospital ventricular fibrillation. A placebo-controlled, double-blind, randomized trial.

One hundred fifty-five consecutive patients resuscitated after out-of-hospital ventricular fibrillation by a physician-manned advanced life support unit were randomly assigned to receive nimodipine or placebo at a dosage of 10 micrograms/kg as an intravenous injection immediately after restoration of spontaneous circulation, followed by an infusion of 0.5 micrograms/kg per minute for 24 hours. No significant difference was found in the 1-year survival rate of nimodipine-treated (30 [40%] of 75 patients) and placebo-treated patients (29 [36%] of 80 patients). Recurrent ventricular fibrillation during the treatment occurred in one patient in the nimodipine group compared with 12 patients in the placebo group. In a post hoc analysis of patients with very long delays in advanced life support (more than 10 minutes), the 1-year survival rate was higher with nimodipine (eight [47%] of 17 patients) than with placebo (two [8%] of 26 patients). Nimodipine may be of benefit in patients with delayed resuscitation.

Aged↗
PubMed1990

Periocular anaesthesia: technique, effectiveness and complications with special reference to postoperative ptosis.

The effectiveness of periocular anaesthesia and its complications were examined in 100 successive cataract operations. The patients were divided into 3 groups according to the duration of ocular compression with an Autopressor device after administration of periocular anaesthesia. In the control group, no compression was used (C-O, n = 36 patients). In the other two groups, compression was used for 10 (C-10, n = 32) and for 20 (C-20, n = 32) min. No differences in globe or orbicular akinesia were found between the groups. At 10 min, immobilisation of the globe in different directions was attained in 60.1-84.5% of the patients. Compression for an additional 10 min did not significantly improve the akinesia. In contrast, the hitherto undescribed loss of light perception increased with time: 15 patients at 10 min and 22 at 20 min were unable to see light. Chemosis and haematomas in the upper eyelid occurred more often in C-0 than in the other 2 groups. One day postoperatively the average palpebral aperture was smaller in C-0 than in the other two groups. The frequent postoperative ptosis (74.3% on the 1st day) decreased rapidly, but on postoperative day 7, 9 patients still had ptosis. In only one patient was ptosis still recognizable at 6 weeks postoperatively. No serious complications occurred. This study demonstrates that periocular anaesthesia with ocular compression is a suitable method for cataract surgery.

Adult↗
PubMed1990

Effect of ocular compression (Autopressor) on intraocular pressure in periocular anaesthesia.

One hundred successive patients were operated on for cataract under periocular anaesthesia. The patients were divided into 3 groups to study the effect of extraocular compression on intraocular pressure. In the control group (C-O), no compression was used. In the other 2 groups, compression was applied immediately after local injection of the anaesthetic for either 10 (C-10) or 20 min (C-20). In the control group, a periocular local anaesthetic increased the IOP in 27 of 36 patients, the average increase being 3.8 mmHg (at 10 min). Postanaesthetic compression of the eye led to a decrease in intraocular pressure, which is beneficial for the operative procedure. During the first 10 min, the mean intraocular pressure decreased by 3.1 and 4.0 mmHg in groups C-10 and C-20, respectively. In the C-20 group, there was a further (1.3 mmHg) reduction in intraocular pressure between 10 and 20 min.

Anesthesia, Local↗
PubMed1990

Comparison of non-invasive respiratory and arterial blood gas analysis. A recovery room study on acute respiratory depression.

The effect on invasive and non-invasive oxygen, carbon dioxide and haemoglobin saturation measures of two repeated doses of alfentanil 0.5 microgram/kg were tested in 16 patients scheduled for elective cataract surgery under periocular anaesthesia. Alfentanil caused an acute respiratory depression, which was demonstrated as increased levels of arterial and end-tidal carbon dioxide and concomitant decrease in arterial and end-tidal oxygen levels as well as decreased arterial blood saturation and pulse oximeter readings. There was a good correlation between the non-invasive respiratory parameters and blood gas levels, as well as between pulse oximetry numbers and oxygen saturation of arterial blood. Therefore, hypoventilation and concurrent hypoxaemia can be predicted by monitoring end-tidal CO2.

Aged↗