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S Bredbacka

Publications and source records attributed to S Bredbacka.

9 recordsLinked to original sources
PubMed2001

Antithrombin treatment in patients with traumatic brain injury: a pilot study.

This study will determine if early administration of antithrombin concentrate to patients with traumatic brain injury (TBI) can inhibit or significantly shorten the time of coagulopathy. The progress of brain injury monitored by computed tomographic scan (CT) was also assessed, as was the time needed for intensive care and outcome related to Glasgow outcome scale (GOS). Twenty-eight patients with isolated brain trauma verified with CT were included in either of two parallel groups. The Glasgow coma score (GCS) was mean 7.5, and median 7.0; signifying a moderate to severe traumatic brain injury but with a mortality of only 3.5%. The patients randomized to antithrombin treatment received a total of 100 U/kg BW during 24 hours. To measure hypercoagulability, soluble fibrin (SF), D-dimer (D-d), and thrombin-antithrombin complex (TAT) were assessed together with antithrombin (AT) and routine coagulation tests. Before treatment, SF, D-d, and TAT were markedly increased in both groups. Soluble fibrin and D-dimer (measured after treatment began) appeared to decrease faster in the AT group, and there was a statistically significant difference between the groups at 36 hours for SF and at 36 hours, 48 hours, and at Day 3 for D-d. Thrombin-antithrombin complex levels were very high in both groups but, surprisingly, showed no significant difference between the groups. The authors conclude that antithrombin concentrate administered to patients with severe TBI resulted in a marginal reduction of hypercoagulation. We could not detect any obvious influence by antithrombin on brain injury progress, on CT, or on outcome or time needed for intensive care.

Adolescent↗
PubMed1994

Soluble fibrin: a predictor for the development and outcome of multiple organ failure.

UNLABELLED: According to our hypothesis ICU patients with signs of early hypercoagulation should develop more organ system failures that result in higher mortality rates and longer treatment periods. Routine coagulation tests are unreliable for measuring early hypercoagulation. METHODS: Soluble fibrin (SF), reflecting hypercoagulation, was assessed at an early stage in 101 ICU patients. A spectrophotometric method using chromogenic peptide substrates was employed. The patients were divided into four groups, depending on the patient's highest level of SF within the first week after admission: Group I (21 patients), SF < 15 nmol/L (reference level); Group II (27 patients), SF 15-29 nmol/L; Group III (26 patients), SF 30-50 nmol/L and Group IV (27 patients), SF > 50 nmol/L. The number of secondary failing organ systems and the ventilator time, ICU time and mortality rates were recorded. RESULTS: There was a significant increase in the number of secondary failing organ systems (P < 0.0001) and a significantly increased mortality for the groups with higher SF (P = 0.01). There was a mean of 0.6, 1.3, 2.4, and 3.4 failing organs and a mortality of 14%, 22%, 30%, and 46% in the respective groups. The ventilator time and the ICU time were longest in Group III, but again shorter for Group IV (with the highest mortality). The mean ventilator times were 2.7, 6.4, 8.4, and 5.9 days and the mean ICU times were 4.1, 8.6, 10.3, and 7.3 days in the respective groups. Thirteen patients with SF > 100 nmol/L had a mean of 4.2 failing organ systems and an 85% mortality. CONCLUSION: Soluble fibrin, a marker of hypercoagulation, seems to predict organ system failure and outcome in ICU patients.

Critical Care↗
PubMed1994

Soluble fibrin and D-dimer as detectors of hypercoagulability in patients with isolated brain trauma.

To test the hypothesis that hypercoagulability after brain trauma was related to the severity of injury and also to outcome, new coagulation markers were used in 20 patients with isolated brain trauma. In addition to routine coagulation tests, soluble fibrin (SF), D-dimer, and antithrombin (AT) levels were assessed. Thirteen of 20 patients had a Glasgow coma score (GCS) of < or = 7 on admission and severe disability (SD) or worse on the Glasgow outcome scale (GOS). Eight patients had a very bad outcome [GOS = dead (D) or vegetative (V)]. All patients had increased SF levels (ref. < 15 nmol/L) at admission. Six patients with SF < 50 nmol/L had a good outcome with moderate disability (MD) or better. Patients with increasingly higher SF levels had a worse outcome: Three of five patients with SF 50 to 150 nmol/L were severely disabled (SD) or worse; four of six patients with SF > 150 nmol/L remained vegetative (V) or died (D). Four of the six patients with the highest D-dimer levels at admission remained vegetative (V) or died (D). Six of 13 patients with a significant drop in AT levels had a bad outcome (D or V) whereas only two of seven patients without AT consumption did poorly. Routine coagulation studies were often pathologic, i.e., reduced platelet count, but there was no relation to outcome. Increased SF and D-dimer levels at admission followed by a secondary decrease in AT concentration and platelets seem to be good markers of the posttraumatic hypercoagulation often seen after brain injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Laboratory methods for detecting disseminated intravascular coagulation (DIC): new aspects.

The objective was to diagnose a hypercoagulative state or "pre-DIC" with new laboratory tests. APACHE II score was used as a measure of primary illness. Ventilator time was used as a reflexion of secondary complications. Twenty-three ICU patients were divided into two groups depending on time on the ventilator: Group 1 > 7 days and Group II < or = 7 days. If, after admittance patients deteriorated or complications occurred, new quantitative coagulation tests were done: soluble fibrin, prothrombin fragment 1 + 2, thrombin-antithrombin complex, D-dimer and elastase. We found a positive correlation between SF levels, the APACHE II score and the ventilator time. Diagnostic efficacy for SF was 87%, sensitivity 91%, specificity 83%, the predictive value of a positive result was 87% and the predictive value of a negative result 91%. The levels of the other new tests were also generally higher in the clinically worse group, although not significantly. Prothrombin complex, APTT, platelet count and AT III were pathologic to the same extent in both groups. The patients who developed most secondary complications, resulting in longer ventilator treatment (Group I), were also hypercoagulative. Soluble fibrin, in particular, seems to be valuable in the diagnosis of "pre-DIC" and possibly of predictive value for organ system complications.

Adult↗
PubMed1987

Activation of cascade systems by hip arthroplasty. No difference between fixation with and without cement.

The acrylic bone cement has been regarded as a very potent activator of the hemostatic mechanisms. A battery of coagulation, fibrinolytic, and kallikrein variables were studied perioperatively in 21 patients undergoing hip arthroplasty with fixation of the prosthesis either with (Charnley) or without (HP-Garches) cement. Epidural analgesia was used and dextran 6 per cent as thromboprophylaxis. The HP-Garches procedure was shorter and caused less blood loss. No differences were found between the two surgical procedures regarding the activation of the cascade systems. The coagulation and fibrinolytic systems were activated early, but a week postoperatively the latter seems to predominate. A marked activation of the kallikrein system was apparent. Our study shows that despite thromboprophylaxis a marked activation of the coagulation, fibrinolytic, and kallikrein systems occurs in relation to hip arthroplasty irrespective of the use or nonuse of cement and irrespective of the volume of blood loss during surgery. It may be the reaming of the bone marrow that initiates the activation of the cascade systems.

Aged↗
PubMed1986

Per- and postoperative changes in coagulation and fibrinolytic variables during abdominal hysterectomy under epidural or general anaesthesia.

Blood coagulation and fibrinolysis were studied in 20 premenopausal women undergoing abdominal hysterectomy under general anaesthesia (GA) or high epidural analgesia (EDA). As expected, the adrenocortical stress response was suppressed in the EDA group. The Factor VIII complex (F VIII:C, F VIII R:Ag = von Willebrand factor), known to be related to adrenocortical activity and/or vessel wall reactivity, was found to increase less in the EDA group. With regard to all the other variables analysed there were no significant differences between the groups. With both anaesthetic procedures activation of coagulation could be demonstrated by a decrease in prekallikrein, F X and antithrombin as well as by an increase in fibrinopeptide A levels. A decrease in plasminogen and alpha 2-antiplasmin suggested activation of the fibrinolytic system and a decrease in prekallikrein and kallikrein inhibition activity (C-1-esterase inhibitor) an activation of the kallikrein system. In this study only the differences in F VIII complex could explain the previously reported higher thromboembolic frequency after GA as compared to EDA.

Adult↗
PubMed1984

Gas exchange during ventilator treatment: a validation of a computerized technique and its comparison with the Douglas bag method.

In recent years a number of commercial instruments for on-line gas exchange measurements has been introduced. One of them, the Engström Metabolic Computer (EMC), is here clinically validated as compared to the standard Douglas bag method for gas sampling and a Centronic Mass Spectrometer (CMS) for gas analysis. VO2, VCO2 and RQ were simultaneously measured and calculated with both methods. Twenty individual gas exchange determinations were made at different times on 12 critically ill patients at the intensive care unit. There was a small but significant difference (P less than 0.025) of 4.3% +/- 8.4% (s.d.) between the two methods when they were used to measure VO2 (the EMC giving the lower value). The corresponding value of VCO2 was 2.4% +/- 9.1% (s.d.), and for RQ the difference was -1.98% +/- 7.1% (s.d.). These differences are not significant at the 95% level of significance. Determinations of oxygen uptake during ventilator treatment with standard methods usually involve technical difficulties and are associated with errors of method around 10%. Our results indicate a probable error of about 8.5% for VO2 in clinical situations. Considering the difficulties involved in determinations of gas exchange, the EMC method seems to be a valuable technique with an accuracy within acceptable limits.

Adult↗
PubMedDate not supplied

Laser-uvulopalatoplasty (LUPP) under local anesthesia: effective, safe and comfortable.

Conventional uvulopalatopharyngoplasty has in the last years to an increasing extent been succeeded by a variety of laser procedures for snorers obstructed by lax palates only. These surgical techniques have the advantages of being less traumatic and therefore more suitable for local anesthesia and outpatient surgery. However, to the authors' knowledge, there are no studies on degree of patient discomfort during this type of surgery as well as the value of anticholinergic component in premedication in preventing bradycardia and hypersalivation during the operation. We studied 53 consecutive patients undergoing laser-uvulopalatoplasty (LUPP) under local anesthesia at our day care unit. LUPP is a one-stage operation for rhonchopathy which has been developed at our department. Twenty-five patients received morphine and scopolamine, and 28 morphine alone as premedication. Peroperative salivation, bradycardia and nausea was estimated and recorded for each group. Later the patients were asked to assess mouth dryness both before and after surgery, as well as satisfaction with sedation and pain relief. The great majority of the patients (> 80%) described only insignificant pain, which when occurring was related to subliminal premedication or to the injection of local anesthesia or both. Morphine-scopolamine was significantly better in preventing hypersalivation (p < 0.01) during surgery and also improved sedation and analgesia when compared to morphine alone (p < 0.05). The efficacy of LUPP is compared with various laser procedures for snoring.

Adult↗