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Biomedical subjects

U Hedstrand

Publications and source records attributed to U Hedstrand.

At least 19 recordsLinked to original sources
PubMed1990

Observations on intracranial dynamics during respiratory physiotherapy in unconscious neurosurgical patients.

The effects of airway care procedures on intracranial dynamics were studied in 12 patients with intracranial lesions. The patients had controlled ventilation and were treated according to a standardized protocol with endotracheal suction and bag squeezing. Intracranial, arterial blood and airway pressures were recorded and cerebral perfusion pressure was calculated. Both methods used for airway care elicited marked changes in intracranial, arterial blood and cerebral perfusion pressures during the treatment session. However, within 1 min after termination of the procedure the different pressure levels returned to pretreatment values except for the intracranial and arterial blood pressure in endotracheal suction. Cerebral perfusion pressure, calculated at different time intervals: 1, 5 and 15 min after the treatment, showed only minor deviations from values before treatment. The mean values varied from 70 to 90 mmHg (9.3 to 12.0 kPa) and the lower limit of the 99% confidence interval of the means was never below 55 mmHg (7.3 kPa). At times complementary administration of sedatives during endotracheal suction was found to induce a drop in arterial blood pressure and cerebral perfusion pressure. In conclusion, patients with severe brain injuries treated on mechanical ventilation are exposed to equal risks when using bag squeezing for airway care as when using traditional endotracheal suction. Regardless of the method used, patients should be adequately sedated before starting the procedure in order to reduce the risk of adverse effects.

Adolescent↗
PubMed1989

Continuous arteriovenous hemofiltration in the treatment of 100 critically ill patients with acute renal failure: report on clinical outcome and nutritional aspects.

The clinical outcome for 100 consecutive patients with multiorgan failure including acute renal failure (ARF) was studied. Fifty-eight of the patients had acute renal failure due to complications during and after major surgery. Seventy-three of the patients had a urine output of less than 400 ml/24 hours. The majority of the patients also had complications such as septicemia or respiratory insufficiency and required vasopressor infusions. All patients were treated with continuous arteriovenous hemofiltration (CAVH). The duration of the CAVH treatment varied between a few hours and 90 days, with a mean of 8 days. The mean ultrafiltration volume per 24 hours was, on the average, 12 liters. CAVH resulted in adequate uremic control in 89 cases, but additional treatment with intermittent hemofiltration was necessary in 11 patients. The total survival rate was 45% including survival rates as high as 54% in patients with ARF complicating abdominal aortic surgery. Only three patients were referred for chronic dialysis therapy. In a subgroup of 17 patients with ARF complicating abdominal aortic surgery the nutritional aspects during CAVH were studied. It is concluded that during CAVH therapy it is possible to give adequate nutritional support even to hypercatabolic and anuric patients.

Acute Kidney Injury↗
PubMed1988

Predictors of electromechanical dissociation during cardiac arrest.

ECG patterns observed during cardiac arrest were analyzed in 261 comatose cardiac arrest survivors. Forty-seven patients (18%) exhibited electromechanical dissociation (EMD) at some point before restoration of stable spontaneous circulation. These patients had a higher mortality (P = .05) and a lower rate of cerebral recovery (P = .01) during the one-year follow-up than study patients who did not exhibit EMD. Patients who developed EMD subsequent to defibrillation had better outcome than patients presenting with EMD. Multivariate analysis revealed that age more than 70 years old (P = .007), pulmonary disease (P less than .001), diabetes (P = .013, in-hospital arrests only), and prearrest hypoxemia (P = .013, outside-hospital arrests only) were independently predictive of the occurrence of EMD. Although the generalizability of these findings is limited, they may offer new clues to the pathophysiology of EMD.

Aged↗
PubMed1987

Quality of life among long-term survivors of intensive care.

Quality of life was examined in 717 individuals 1 yr after their admission to a multidisciplinary ICU. Of these, 87% were able to live at home 6 months after their admission. Of patients 65 yr and older, 90% had been living independently before admission compared to 80% 1 yr afterward. Of those younger than 65 yr, most of the 65% who had been working before admission could return to work. The length of hospitalization during the first year after admission varied greatly; 10% of the patients stayed more than 145 days. The patients who needed mechanical ventilation or who stayed 1 wk or more in the ICU tended to have worse outcomes than others. These data indicate that there is no great deterioration in quality of life among long-term survivors of intensive care.

Adolescent↗
PubMed1987

Prediction of outcome after cardiac arrest.

Neurologic outcome of hypoxic ischemic coma after cardiac arrest was studied in 32 patients. Observations were made and samples collected 24 and 48 h after the ischemic insult. The Glasgow-Pittsburgh coma score was assessed for its prognostic value. Other variables studied were the EEG and adenylate kinase, lactate and glutathione in the cerebrospinal fluid (CSF). Outcome was termed good if the patients resumed an independent life within a 6-month follow-up period. The closest correlations between prediction and good outcome occurred with the Glasgow-Pittsburgh coma score (94%) and the EEG (77%) at the 48-h examination, a modified coma score (96%) at 48 h, and CSF lactate (78%) at 24 h. Some simple neurologic signs (e.g., no withdrawal response to pain) at stated points in time was 100% associated with a bad outcome, although their absence was not associated necessarily with a good prognosis.

Adenylate Kinase↗
PubMed1987

Prevention of intraoperative hypothermia during abdominal surgery.

Heat balance and core and skin temperatures were studied in 111 patients during abdominal surgery. In minor surgical procedures the effects of heating of inspired humidified gases (n = 23) and of a heating mattress (n = 21) were compared with the conditions in an unwarmed control group (n = 24). These two methods were about equally effective in preserving total body heat, although the major effect of the heating mattress was to conserve heat which had been redistributed to the surface, and such heat could subsequently be lost to the environment. During major abdominal surgery 18 unwarmed control patients were compared with patients (n = 25) provided with a heat supply. The combined measures of heated humidified inspired gases, a heating mattress, insulation by a heat-reflecting blanket, warming of all infusions and transfusions and a warm operating room were all needed to balance the great heat losses during the major surgical procedures. With such massive heat supply it was possible to prevent heat loss and a fall in core temperature.

Abdomen↗
PubMed1987

Postoperative complications after blood replacement with or without plasma. A trial in elective surgery.

A prospective, controlled and randomized study of 275 patients undergoing major surgery was performed to investigate if postoperative complications were influenced by restrictive use of plasma to replace operative blood loss. All patients were given 6% dextran (Macrodex) for thromboprophylaxis and haemodilution. The "Dextran Group" received equal amounts of 6% dextran and electrolyte solution as substitution for plasma loss. The need for red-cell transfusion (60% suspension in saline-adenine-glucose-mannitol storage medium) averaged 5.8 units in this group and 5.2 in the "Plasma Group". The respective mean totals of infused plasma and dextran were 400 ml and 1,383 ml in the Dextran Group, compared with 1,099 and 619 ml in the Plasma Group. The mean total electrolyte infusion in the first postoperative week was c. 7,500 ml in both groups. Serum albumin decreased considerably in both groups, but significantly more in the Dextran Group. The incidence and pattern of postoperative complications were similar in both groups. When blood loss is up to 50-60% of the total volume, Macrodex can be used in preference to plasma, unless administration of plasma protein is specifically indicated.

Dextrans↗
PubMed1986

Adult respiratory distress syndrome after renal transplantation. A case report.

A potentially lethal case of "air-borne" adult respiratory distress syndrome, most likely consequent to cytomegalovirus (CMV) pneumonitis, is described in a kidney transplant patient. It was characterized by confluent densities on both lung fields with peripheral zones of normal radiographic pattern and with one of the highest values of extravascular lung water reported in the literature, in the presence of a normal pulmonary capillary wedge pressure. When specific conservative therapy for curing a potentially lethal CMV pneumonitis after kidney transplantation fails, we suggest that transplantectomy should be considered.

Adult↗
PubMed1986

Low-dose ketamine infusion for analgesia during postoperative ventilator treatment.

In a randomized, double-blind study with placebo, ketamine was used as an analgesic during ventilator treatment in the period of recovery after major abdominal surgery. Forty patients were orally intubated and ventilated by means of a volume-controlled ventilator. Twenty of them received an i.v. bolus of 30 mg of ketamine followed by an 8-h infusion of 1 mg per minute. End-tidal CO2-concentration was continuously monitored and ventilation was adjusted to metabolic demands prior to assessment of pain. If pain relief was not adequate, the infusion rate was doubled, and if this was still not sufficient, 5 mg injections of ketobemidone were given i.v. If the orotracheal tube was not tolerated, the internal branch of the superior laryngeal nerve was blocked. A total of 30 injections of ketobemidone were administered to 13 control patients, but only five were given to four ketamine patients. Ten control and three ketamine patients required an internal laryngeal nerve block. Dreams and hallucinations were recalled in three patients in the control group and five in the ketamine group. Only one control and two ketamine patients experienced these as unpleasant. In this investigation, ketamine infusion in a low dose appeared to offer satisfactory analgesia and to permit tolerance of the orotracheal tube.

Aged↗
PubMed1985

Determinants of early adult respiratory distress syndrome. A retrospective study of 220 patients with major fractures.

The records of 220 consecutive trauma patients admitted to intensive care in the period 1974 through 1982 were reviewed in an attempt to find determinants of early adult respiratory distress syndrome (ARDS). All the patients were considered to be at risk of ARDS and had major fractures without concomitant severe injuries to brain, chest or abdomen. No patient died. ARDS developed in 27 patients (12.3%), on average in the second day post-trauma. The clinical determinants of post-traumatic ARDS were high fracture index, implying severe tissue trauma, and shock on admission. Fluid overload was not found to cause ARDS. Conventional signs of disseminated intravascular coagulation (DIC) were not predictive or diagnostic of ARDS, but were related to the transfused amount of stored blood. Chest radiography was indicative of ARDS in 21 cases, but in six it was normal despite hypoxaemia. In the cases with radiographic signs of ARDS there was generally good chronologic correspondence with hypoxaemia. Ventilation with positive end-expiratory pressure may prevent the classic radiographic picture of ARDS with alveolar densities.

Adolescent↗
PubMed1983

Cerebrospinal fluid markers in relation to outcome in patients with global cerebral ischemia.

To investigate the possibility of improving the accuracy of prognostication in early hypoxic brain damage, 12 patients with global cerebral ischemia (GCI) due to circulatory arrest outside hospital were followed until death or for 1 yr. Five who survived for more than 2 weeks displayed better values on coma scoring from 16 h-3 days, compared to those who succumbed within 2 weeks. In 2 week-survivors, lumbar puncture revealed consistently lower adenylate kinase (AK) activity in cerebrospinal fluid (CSF) at 24 h than in the other patients, whereas glutathione and lactate values overlapped to some degree. The CSF-AK activity at 48--72 h was less correlated to clinical outcome. It is concluded that the results from coma scoring, based upon clinical observation, and from determination of AK activity in CSF at 24 h reinforce each other in discriminative power to predict prognosis in these patients.

Adenylate Kinase↗
PubMed1983

Fibrinolysis inhibition and fibronectin in the blood in patients with the delayed microembolism syndrome.

Various parameters of fibrinolysis inhibition and the plasma concentration of fibronectin (alpha 2-surface binding glycoprotein, cold insoluble globulin) were measured in patients at risk of developing acute progressive respiratory sufficiency following trauma or sepsis - the delayed microembolism syndrome (DMS). Most parameters measuring fibrinolysis inhibition were significantly higher in the five patients with DMS than in five patients who did not develop the syndrome. Thus, the primary fibrinolysis inhibitor (alpha 2-antiplasmin) was enhanced and the alpha-form of this inhibitor, with affinity to plasminogen, showed the greatest increment and might be of major importance for the delayed elimination of fibrin from the lungs occurring in these patients. The fibronectin concentrations were not lower in patients with DMS than in those who did not develop the syndrome.

Adult↗
PubMed1982

Oleic acid lung damage in pigs.

With the purpose of producing a lung damage model simulating post-traumatic pulmonary insufficiency, oleic acid 0.1 ml . kg-1 body weight (b.w.) was infused intravenously into eight mechanically ventilated young pigs, and the effects were studied for 2 h. After the infusion, PaO2 during air breathing decreased to a fairly low and stable level of about 7 kPa. Venous admixture during air breathing and VD/VT showed a marked initial increase and then remained unchanged, while venous admixture during breathing of pure oxygen increased but less markedly. Haematocrit (EVF), arterial carbon dioxide tension (PaCO2) and base excess (BE) were unchanged. Mean pulmonary arterial pressure more than doubled and cardiac output decreased by 1/3, which was considered to reflect an insuperable increase in the resistance of the pulmonary blood flow. The lung model was found to resemble post-traumatic pulmonary insufficiency with respect both to the V/Q ratio displacement and to the macroscopic appearance of the lungs at autopsy.

Animals↗
PubMed1981

Albumin treatment following major surgery. I. Effects on plasma oncotic pressure, renal function and peripheral oedema.

The effect of a 20% albumin solution on plasma oncotic pressure, renal function and peripheral oedema was investigated in 30 adult patients undergoing elective major abdominal surgery. Half of them received an average of 173 g of albumin between the end of the operation and the 5th postoperative day, in accordance with a standardized scheme. Otherwise the same schedules for fluid therapy and blood replacement were followed in all patients. Postoperatively, serum albumin and plasma oncotic pressure were fairly normal in the albumin group, but decreased by 28% and 24% in the control group. The difference between the groups was statistically significant during the first week, but disappeared during the second week. Arm and thigh circumferences increased postoperatively to a similar extent in both groups. There were no apparent differences in circulatory variables, alveolo-arterial oxygen tension difference, incidence of wound infection or postoperative restoration of intestinal activity between the groups. Although renal and thromboembolic complications occurred only in the control group, the material is too small to permit any conclusions to be drawn from the possible difference in renal function and morbidity between the groups. The limited availability and high cost of albumin require strict indications for its use. Our results so far have failed to justify routine administration of concentrated albumin postoperatively.

Abdomen↗