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P Vaagenes

Publications and source records attributed to P Vaagenes.

At least 19 recordsLinked to original sources
PubMed2003

Modest protection of early hydrocortisone treatment in a rat model of volume-controlled haemorrhage.

BACKGROUND: Major insults may trigger generalized inflammatory responses that contribute to progressive multiple organ dysfunction. The present study was performed to test the potential of early hydrocortisone treatment to influence these responses as well as organ function following an episode of rapid and profound blood loss. METHODS: In isoflurane anaesthesia, 35 spontaneously breathing male Sprague-Dawley rats were bled 2.5 ml 100 g-1 body weight over 10 min. Immediately following withdrawal of blood, one group (n = 17) was given 2 mg of hydrocortisone, and the other (n = 18) had the same amount of normal saline. Seventy-five minutes after initiation of bleeding, two-thirds of the blood was retransfused, together with a new injection of hydrocortisone or saline. Thereafter the rats were observed for 2 h. Key mediators of systemic inflammation and plasma markers of organ function and integrity were measured. Internal organs were weighed and scored for visible pathology. Leukocyte infiltration of the liver was counted in a light microscope. RESULTS: Hydrocortisone reduced the plasma levels of IL-6 (P < 0.05); non-significant reductions of TNF-alpha (P = 0.12) and IL-10 (P = 0.44) were noted. The synthesis of reactive oxygen species in peritoneal cells was unaffected. Relative organ weights and organ injury scores tended to be reduced, but only wet organ weight for the lungs reached statistical significance. Leukocyte infiltration of the liver was equal in both groups. Plasma levels of ALT, AST, alpha-GST and creatinine did not differ significantly between groups. Two of the hydrocortisone treated rats died compared with four controls. CONCLUSION: Early treatment with hydrocortisone had a limited organ protective effect in this model of controlled haemorrhagic shock. Although a general tendency for better outcome in the hydrocortisone group was noted, clear-cut and significant advantages of the treatment were not obtained.

Animals↗
PubMed2001

[Steroid treatment of shock lung--tune for re-evaluation?].

BACKGROUND: The acute respiratory distress syndrome (ARDS) is one consequence of the body's systemic inflammatory response to a variety of powerful external stimuli. Glucocorticosteroids are highly effective anti-inflammatory drugs. During the last few years, the molecular mechanisms for their mode of action have been revealed; this has prompted a new wave of interest in corticosteroid treatment of systemic inflammatory states. Several clinical studies have been launched; the results have so far been promising. MATERIAL AND METHODS: We briefly discuss how new knowledge in this field may influence the use of corticosteroids in the treatment of ARDS. The presentation is illustrated by a case study. RESULTS: The patient was a 15-year-old boy with life-threatening and therapy-resistant ARDS. He was treated in a respirator in an intensive care unit (ICU). Two weeks after admission to the ICU, his situation was desperate. High-dose corticosteroids were instituted, and during a five days' treatment his condition improved dramatically. After discontinuation of glucocorticoids he made further progress and was discharged from the ICU after another eleven days. INTERPRETATION: In this particular patient, administration of glucocorticoids had a striking effect. The influence of glucocorticoids on the activation of the transcription factor NF-kappa B and a resulting reduced synthesis of a number of key inflammatory molecules may be one explanation for the positive course.

Acute Disease↗
PubMed2001

Moderate hypothermia blunts the inflammatory response and reduces organ injury after acute haemorrhage.

BACKGROUND: Reduced body temperature is a common companion to trauma/haemorrhage. Several clinical studies have identified hypothermia as an independent risk variable predisposing to increased morbidity and mortality. At the same time it is known that most enzymatic reactions are downregulated at temperatures below 37 degrees C. Theoretically this should restrain the inflammatory response and protect the host from remote organ injury. The study was performed to test this hypothesis. METHODS: Twenty-six male Sprague Dawley rats were used for the experiments. Volume controlled haemorrhagic shock was induced by withdrawal of 2.5 ml blood/100 g body weight over 10 min. Half of the animals (n=13) were then cooled to 32.5-33 degrees C, the other half (n=13) were kept normothermic (37.5+/-0.5 degrees C). Seventy-five minutes after initiation of bleeding, two-thirds of the blood was retransfused. Thereafter the rats were observed for 2 h. Key substances of systemic inflammation were determined (plasma values of TNF-alpha, IL-6, IL-10, and corticosterone; reactive oxygen species in peritoneal phagocytes), plasma markers of organ function and integrity (AST, ALT, alphaGST, creatinine, urea), and survival. RESULTS: Hypothermia reduced the release of IL-6 (P<0.01). The reductions of plasma levels of TNFalpha (P=0.07) and IL-10 (P=0.09) were less clear-cut. The release of reactive oxygen species diminished (P<0.01). Organ injury was ameliorated, as reflected by decreased levels of AST (P<0.01), alphaGST (P<0.01), and creatinine (P<0.01). Both groups experienced an almost identical increase of plasma corticosterone. None of the hypothermic rats died, compared to two normothermic. CONCLUSION: Moderate hypothermia had an organ protective effect in this model of controlled haemorrhagic shock. This coincided with a significant reduction of the proximal cytokine IL-6 and reactive oxygen species, which conceivably influenced the outcome.

Animals↗
PubMed2000

[Day surgery of hernia].

INTRODUCTION: Reduced economic resources have been a stimulus for increased day-case surgery, and an incentive for improving surgical technique and anaesthetic methods. In hernia surgery it is important to avoid recurrence and reoperation, which seems to be more easily achieved by the use of mesh prosthetics. For anaesthesia, costs may possibly be reduced by the use of spinal blockade instead of general anaesthesia, but also local infiltration anaesthesia is regaining popularity. We found it appropriate to evaluate and compare relevant factors associated with the use of these two anaesthetic techniques in our day-case surgery. MATERIAL AND METHODS: Evaluation and analysis of the anaesthetic and postoperative notes on 413 adult patients with inguinal hernia operated in local anaesthesia and 121 patients operated in spinal anaesthesia. RESULTS: Cardiovascular, respiratory and neurological problems were more frequent and more severe in the spinal than in the local anaesthesia group, whereas the need for extra analgesia and sedation perioperatively was higher in the local group. Time spent in the operating room was shorter, and early ambulation appeared to lead to less discomfort in the local anaesthesia group. INTERPRETATION: The results indicate that local infiltration is a safe, simple and effective technique when used for operations of abdominal hernias in adult patients, and can be recommended for day-case surgery of reducible inguinal hernias.

Adult↗
PubMed1997

Asphyxiation versus ventricular fibrillation cardiac arrest in dogs. Differences in cerebral resuscitation effects--a preliminary study.

UNLABELLED: We explored the hypothesis that brain damage after cardiac arrest caused by ventricular fibrillation (VF) needs different therapies than that after asphyxiation, which has been studied less thoroughly. In 67 healthy mongrel dogs of both sexes cardiac arrest (at normothermia) by ventricular fibrillation (no blood flow lasting 10 min) or asphyxiation (no blood flow lasting 7 min) was reversed by normothermic external cardiopulmonary resuscitation, followed by intermittent positive-pressure ventilation for 20 h, and intensive care to 96 h. To ameliorate ischemic brain damage, the calcium entry blocker lidoflazine or a solution of free radical scavengers (mannitol and L-methionine in dextran 40) plus magnesium sulphate, was given intravenously immediately upon restoration of spontaneous circulation. Outcome was evaluated as functional deficit, brain creatine kinase (CK) leakage into the cerebrospinal fluid (CSF) and brain morphologic changes. Lidoflazine seemed to improve cerebral outcome after VF but not after asphyxiation. Free radical scavengers plus magnesium sulphate seemed to improve cerebral outcome after asphyxiation, but not after VF. After VF, scattered ischemic neuronal changes in multiple brain regions dominated, and total brain histopathologic damage scores correlated with final neurologic deficit scores at 96 h (r = 0.66) and with peak CK levels in CSF (r = 0.81). After asphyxiation, in addition to the same ischemic neuronal changes, microinfarcts occurred, and there was no correlation between total brain histopathologic damage scores and neurologic deficit scores or CK levels in CSF. CONCLUSIONS: Different mechanisms of cardiac arrest, which cause different morphologic patterns of brain damage, may need different cerebral resuscitation treatments.

Animals↗
PubMed1996

Cerebral resuscitation from cardiac arrest: pathophysiologic mechanisms.

Both the period of total circulatory arrest to the brain and postischemic-anoxic encephalopathy (cerebral postresuscitation syndrome or disease), after normothermic cardiac arrests of between 5 and 20 mins (no-flow), contribute to complex physiologic and chemical derangements. The best documented derangements include the delayed protracted inhomogeneous cerebral hypoperfusion (despite controlled normotension), excitotoxicity as an explanation for selectively vulnerable brain regions and neurons, and free radical-triggered chemical cascades to lipid peroxidation of membranes. Protracted hypoxemia without cardiac arrest (e.g., very high altitude) can cause angiogenesis; the trigger of it, which lyses basement membranes, might be a factor in post-cardiac arrest encephalopathy. Questions to be explored include: What are the changes and effects on outcome of neurotransmitters (other than glutamate), of catecholamines, of vascular changes (microinfarcts seen after asphyxia), osmotic gradients, free-radical reactions, DNA cleavage, and transient extracerebral organ malfunction? For future mechanism-oriented studies of the brain after cardiac arrest and innovative cardiopulmonary-cerebral resuscitation, increasingly reproducible outcome models of temporary global brain ischemia in rats and dogs are now available. Disagreements exist between experienced investigative groups on the most informative method for quantitative evaluation of morphologic brain damage. There is agreement on the desirability of using not only functional deficit and chemical changes, but also morphologic damage as end points.

Altitude Sickness↗
PubMed1995

Organ function during early acute renal failure does not predict survival in long-term intensive care.

OBJECTIVE: To examine outcome in relation to organ function variables during early acute renal failure (ARF). DESIGN: Retrospective inception cohort. SETTING: General intensive care unit (ICU). PATIENTS: 69 consecutive ARF cases verified to have a creatinine clearance below 50 ml/min with no history of previous renal disease. MAIN OUTCOME MEASURE: ICU survival. MEASUREMENTS AND RESULTS: Septic severity score (SSS), creatinine clearance, thrombocyte count, bilirubin concentration, cardiac inotropic support, PaO2/FIO2 ratio and oliguria were measured. No differences related to outcome were observed in patients surviving more than 7 days after ARF diagnosis. Patients dying within 7 days of ARF had a significantly higher (worse) SSS. Organ dysfunction was established at the time of ICU admission in the majority of cases. CONCLUSION: The organ function variables tested in this study are of limited predictive value during the early stage of ARF.

Acute Kidney Injury↗
PubMed1994

The use of cytosolic enzyme increase in cerebrospinal fluid of patients resuscitated after cardiac arrest. Brain Resuscitation Clinical Trial I Study Group.

Levels of brain creatine phosphokinase (CPK), glutamic oxalic transaminase, lactate dehydrogenase, and lactate in lumbar cerebrospinal fluid (CSF) were analyzed as an adjunctive study in a randomized clinical trial evaluating the effects of thiopental loading intravenously in comatose survivors of cardiac arrest. Three hospitals participated and a total of 62 cases of enzyme changes were studied. Enzyme levels but not lactate were higher at 48 hours than at 24 hours after restoration of spontaneous circulation. All enzymes were highly correlated with one another at 24 and 48 hours (P < .001). There was a significant negative correlation between cerebral recovery and increased CPK levels at 24 hours (P < .05), and a highly significant correlation with all three enzyme levels at 48 hours (P < .0001). The increase of cytosolic enzyme activity in lumbar CSF reflects permanent brain damage, and there is a relationship between activity levels and cerebral outcome.

Aspartate Aminotransferases↗
PubMed1993

[Drowning--near drowning].

In Norway the number of deaths per year from drowning is approximately nine persons per 100,000, most of them men between 25 and 40 years of age. About 60% of these persons can swim, and 50% of the deaths are related to intake of alcohol. About 6% of the drowned are children, most of them boys. In disaster medicine, drowning is associated with accidents at sea, involving large vessels or small boats, or connected to offshore activities. The important pathological events are directly related to asphyxia, hypoxemia, hypercarbia, pulmonary oedema, and circulatory arrest. This paper describes various aspects of drowning and the pathophysiological processes involved, and discusses differences between drowning and near drowning in fresh water and salt water. Although treatment is basically centred on effective cardiopulmonary resuscitation, there are certain differences with regard to further treatment and fluid/electrolyte management. Hypothermia is often a prominent feature, and if cardiopulmonary resuscitation is successful, hypoxic brain damage may be ameliorated by the fall in body temperature.

Adult↗
PubMed1993

[Local frostbites].

Injury from cold is not an uncommon complication in emergency and disaster medicine under arctic or subarctic conditions. Severe local exposure to cold may have a mutilating effect on the parts of the body involved. This paper briefly summarizes relevant pathophysiological features, how cold injuries are classified, the most important clinical findings, complications and aspects of recommended treatment.

Emergencies↗
PubMed1993

[Accidental hypothermia].

Accidental hypothermia is an important clinical condition in emergency and disaster medicine. It is usually classified as mild, moderate, severe, or extreme (body temperature below 18-20 degrees C; no recordable EEG activity). However, exposure time, trauma, serious illness, or the effects of drugs or alcohol may both attenuate and complicate the clinical course. This paper describes exposure mechanisms, the pathophysiologic processes, the body's thermo-regulating mechanism and diagnostic criteria. The author also discusses choice of treatment in the acute stages, during transportation and in hospital. The treatment should take into account not only the degree of hypothermia, but also exposure time, state of consciousness, and complicating factors such as trauma, drugs or alcohol. When hypothermia is associated with cardiac arrest, rewarming by extracorporal support is recommended.

Accidents↗
PubMed1990

[Electric injuries. Physiopathology and principles of treatment].

This paper describes the basic physical aspects of electricity and the harmful effects of electric shock to the various human organ systems. Treatment of electrical injuries differs from treatment of burns. Damage to muscles and subcutaneous structures necessitates a more aggressive fluid replacement regimen than the one predicted by the commonly used burn fluid resuscitation formulas. It is of paramount importance to avoid renal complications. Early fasciotomy and repeated surgical debridements are often necessary. Routine arrhythmia-monitoring is now considered unnecessary in individuals exposed to low tension alternating current unless arrhythmias requiring treatment are present at the primary medical contact.

Acute Kidney Injury↗
PubMed1990

[Injuries caused by electricity].

We review a patient material consisting of cases with electrical injuries submitted to Sentralsykehuset i Akershus, Norway over a period of ten years. 18 cases were treated during the period 1 January 1978 to 31 December 1987. All were men, with a mean age of 33 years. All injuries were caused by AC current; seven were low voltage, and 11 high voltage injuries. The low voltage injuries proved to be relatively innocent, but 2/11 with high voltage injuries died. Many of the high voltage patients had severe deep tissue, mainly muscular, damage. The two who died had respiratory arrest, were unconscious on admission and had cardiac arrest. Only one with cardiac arrest on admission and two with respiratory arrest survived; three of the five who were unconscious on admission survived. Optimal treatment of injuries caused by electricity requires a thorough understanding of the special pathophysiology of this condition.

Adolescent↗
PubMed1989

Effect of cardiac arrest time on cortical cerebral blood flow during subsequent standard external cardiopulmonary resuscitation in rabbits.

Standard external cardiopulmonary resuscitation (SECPR) produces high cerebral venous and intracranial pressure peaks, low cerebral perfusion pressure, and low cerebral blood flow (CBF). Cerebral viability seems to require 20% of normal CBF, which SECPR cannot reliably generate. We tested the hypothesis that SECPR can produce adequate CBF if started immediately, but not if started after a long period of cardiac arrest (no flow, stasis). Cardiac arrest times of 1, 3, 5, 7 and 9 min were studied in rabbits. We measured unifocal cortical CBF with H2 clearance curves after saturation with H2 10%, O2 50% and N2O 40% by intermittent positive-pressure ventilation (IPPV). Measurements were made during spontaneous circulation (control condition), and then after resaturation immediately before induction of asystole by KCl i.v., and H2 clearance starting at end of arrest time during SECPR-basic life support with IPPV 100% and manual chest compressions (120/min) during asystole. Control cortical CBF was 30-40 ml/100 g brain per min. During asystole and SECPR, CBF greater than 20% normal was achieved only after no-flow of 1 min. After longer arrest (no-flow) times, CBF was less than 20% normal. Values were near zero after 7 and 9 min of cardiac arrest. Decrease in mean arterial pressures (MAP) produced by SECPR during asystole paralleled CBF values. Thus, the longer the preceding period of stasis, the lower the MAP and CBF generated by SECPR without epinephrine. This effect may be the result of anoxia-induced vasoparalysis and stasis-induced increased blood viscosity.

Animals↗