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  • 1.
    Vogel, Gisela
    et al.
    Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology; Intensive Care, Södersjukhuset, Stockholm, Sweden.
    Forinder, Ulla
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för socialt arbete och psykologi, Socialt arbete.
    Sandgren, A.
    Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Svensen, C.
    Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology; Intensive Care, Södersjukhuset, Stockholm, Sweden.
    Joelsson-Alm, Eva
    Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology; Intensive Care, Södersjukhuset, Stockholm, Sweden.
    Health-related quality of life after general surgical intensive care2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 8, s. 1112-1119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Impaired mental and physical health are common complications after intensive care that could influence the patient's health-related quality of life (HRQoL). Earlier research has mainly focused on HRQoL in mixed surgical and medical ICU populations. This study aimed to describe and analyze factors associated with HROoL after discharge from a general surgical ICU.

    METHODS: A prospective cohort study was conducted in a general surgical ICU in Sweden between 2005 and 2012. Adult patients (≥18 years) with an ICU length of stay ≥96 hours were included. HRQoL was measured at 3, 6, and 12 months after discharge from the ICU using a questionnaire (SF-36). A linear mixed model was used to analyze changes over time and Wilcoxon Signed Rank Tests were used to compare the 12-months results to an age and gender matched reference population in Sweden. Linear regression analyses were performed to explore the impact on HRQoL from background variables.

    RESULTS: Of 447 patients eligible for the study, 276 patients (62%) answered SF-36 at least once at 3, 6 or 12 months after ICU care and were included in the study. HRQoL improved over time but was still significantly lower at 12 months compared to the reference population. Female gender, age <75 years, living single, and ICU-stay of more than 14 days were associated with lower HRQoL.

    CONCLUSION: General surgical ICU patients reports low HRQoL 1 year after ICU stay. The impaired HRQoL could be a long-lasting problem with major consequences for the individual, family, and society.

  • 2.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Elna-Marie
    Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
    Raininko, Raili
    Department of Surgical Sciences Radiology, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences Anaesthesiology & Intensive Care, Uppsala University, Uppsala, Sweden.
    Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 5, s. 625-647Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

    METHODS:

    A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

    RESULTS:

    Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

    CONCLUSIONS:

    Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

  • 3.
    Wallin, Ewa
    et al.
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Larsson, Ing-Marie
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Nordmark-Grass, Johanna
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Rosenqvist, Ivan
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rubertsson, Sten
    Department of Surgical Sciences - Anaestesiology & Intensive Care, Uppsala University, Uppsala Sweden.
    Characteristics of jugular bulb oxygen saturationin patients after cardiac arrest: A prospective study2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 9, s. 1237-1245Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied.

    METHOD:

    Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).

    RESULTS:

    Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).

    CONCLUSIONS:

    Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.

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