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  • 1
    Language: English
    In: The New England journal of medicine, 2014-09-18, Vol.371 (12), p.1111-1120
    Description: In a randomized trial, over 7000 patients with ST-segment elevation MI were assigned to undergo thrombus aspiration followed by percutaneous coronary intervention or PCI alone. At 1 year, there was no significant between-group difference in the rate of death from any cause. Acute ST-segment elevation myocardial infarction (STEMI) is often caused by intracoronary thrombus formation with blockage of antegrade coronary flow leading to myocardial ischemia and cell death. 1 Thrombus burden, reduced coronary flow, and reduced myocardial perfusion are important predictors of a poor clinical outcome, including recurrence of myocardial infarction, stent thrombosis, and death. 2 Prompt initiation of antithrombotic therapy in combination with percutaneous coronary intervention (PCI) is the preferred approach to optimize myocardial perfusion and clinical outcomes. 3 Coronary-artery thrombus aspiration before PCI reduces the thrombus burden and improves ST-segment resolution and coronary flow. 4 , 5 To our knowledge, however, no adequately powered randomized . . .
    Subject(s): Abridged Index Medicus ; Aged ; Allmänmedicin ; Biological and medical sciences ; Blood clot ; Blood clots ; Cardiac and Cardiovascular Systems ; Cardiology. Vascular system ; Cause of Death ; Clinical Medicine ; Clinical outcomes ; Clinical trials ; Combined Modality Therapy ; Complications and side effects ; Coronary heart disease ; Coronary Restenosis ; Coronary Thrombosis - therapy ; Death ; Development and progression ; Electrocardiography ; Female ; General aspects ; General Practice ; Health and Caring Sciences ; Heart ; Heart attack ; Heart attacks ; Humans ; Hälsovetenskap ; Implants ; Kaplan-Meier Estimate ; Kardiologi ; Klinisk medicin ; Male ; Medical and Health Sciences ; Medical imaging ; Medical sciences ; Medicin och hälsovetenskap ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Myocarditis. Cardiomyopathies ; Patient outcomes ; Patient Readmission ; Percutaneous Coronary Intervention ; Radiologi och bildbehandling ; Radiology, Nuclear Medicine and Medical Imaging ; Research ; Risk factors ; Suction ; Thrombosis ; Veins & arteries
    ISSN: 0028-4793
    ISSN: 1533-4406
    E-ISSN: 1533-4406
    Source: Alma/SFX Local Collection
    Source: SWEPUB Freely available online
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  • 2
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2019-10, Vol.63 (9), p.1210-1215
    Description: Background Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care. Methods Registry study using data from the Swedish Intensive Care Registry (SIR) 2014‐2016. Age, condition at admission, including co‐morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group. Results Of all 97 095 cases, 47.1% were 61‐80 years old, 41.9% were women and 58.1% men. 14 996 (15.4%) were allocated to the WW group and 82 149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P 〈 0.001), had higher SAPS 3 (P 〈 0.001) and were predominantly female (P 〈 0.001). Compared to patients 16‐20 years old, patients 〉81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084‐1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13‐ 1.23). Conclusion Older age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care.
    Subject(s): age ; Anestesi och intensivvård ; Anesthesiology ; Anesthesiology and Intensive Care ; ethics ; Life Sciences & Biomedicine ; life-sustaining care ; SAPS 3 ; Science & Technology ; sex
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Hellenic Academic Libraries Link
    Source: Academic Search Ultimate
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
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  • 3
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2020-10, Vol.64 (9), p.1335-1342
    Description: Background The onset of cerebral ischemia is difficult to predict in patients with altered consciousness using the methods available. We hypothesize that changes in Heart Rate Variability (HRV), Near‐Infrared Spectroscopy (NIRS), and Electroencephalography (EEG) correlated with clinical data and processed by artificial intelligence (AI) can indicate the development of imminent cerebral ischemia and reperfusion, respectively. This study aimed to develop a method that enables detection of imminent cerebral ischemia in unconscious patients, noninvasively and with the support of AI. Methods This prospective observational study will include patients undergoing elective surgery for carotid endarterectomy and patients undergoing acute endovascular embolectomy for cerebral arterial embolism. HRV, NIRS, and EEG measurements and clinical information on patient status will be collected and processed using machine learning. The study will take place at Sahlgrenska University Hospital, Gothenburg, Sweden. Inclusion will start in September 2020, and patients will be included until a robust model can be constructed. By analyzing changes in HRV, EEG, and NIRS measurements in conjunction with cerebral ischemia or cerebral reperfusion, it should be possible to train artificial neural networks to detect patterns of impending cerebral ischemia. The analysis will be performed using machine learning with long short‐term memory artificial neural networks combined with convolutional layers to identify patterns consistent with cerebral ischemia and reperfusion. Discussion Early signs of cerebral ischemia could be detected more rapidly by identifying patterns in integrated, continuously collected physiological data processed by AI. Clinicians could then be alerted, and appropriate actions could be taken to improve patient outcomes.
    Subject(s): Anestesi och intensivvård ; Anesthesiology ; Anesthesiology and Intensive Care ; artificial intelligence ; cerebral ischemia ; cerebral reperfusion ; doppler ; eeg ; individual patient data ; machine learning ; monitoring ; near-infrared spectroscopy ; stroke ; transcranial
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Hellenic Academic Libraries Link
    Source: Academic Search Ultimate
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  • 4
    Language: English
    In: Acta neurologica Scandinavica, 2021-02, Vol.143 (2), p.195-205
    Description: Objectives Recent reports suggest an association between the inflammatory response after aneurysmal subarachnoid haemorrhage (aSAH) and patients' outcome. The primary aim of this study was to identify a potential association between the inflammatory response after aSAH and 1‐year outcome. The secondary aim was to investigate whether the inflammatory response after aSAH could predict the development of delayed cerebral ischaemia (DCI). Materials and methods This prospective observational pilot study included patients with an aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, between May 2015 and October 2016. The patients were stratified according to the extended Glasgow Outcome Scale (GOSE) as having an unfavourable (score: 1–4) or favourable outcome (score: 5–8). Furthermore, patients were stratified depending on development of DCI or not. Patient data and blood samples were collected and analysed at admission and after 10 days. Results Elevated serum concentrations of inflammatory markers such as tumour necrosis factor‐α and interleukin (IL)‐6, IL‐1Ra, C‐reactive protein and intercellular adhesion molecule‐1 were detected in patients with unfavourable outcome. When adjustments for Glasgow coma scale were made, only IL‐1Ra remained significantly associated with poor outcome (p = 0.012). The inflammatory response after aSAH was not predictive of the development of DCI. Conclusion Elevated serum concentrations of inflammatory markers were associated with poor neurological outcome 1‐year after aSAH. However, inflammatory markers are affected by many clinical events, and when adjustments were made, only IL‐1Ra remained significantly associated with poor outcome. The robustness of these results needs to be tested in a larger trial.
    Subject(s): Adult ; Aged ; Anestesi och intensivvård ; Anesthesiology and Intensive Care ; Biomarkers - blood ; Brain Ischemia - blood ; Brain Ischemia - etiology ; Brain Ischemia - pathology ; C-Reactive Protein - analysis ; Clinical Medicine ; delayed cerebral ischaemia ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Inflammation ; Intercellular Adhesion Molecule-1 - blood ; Interleukins ; Interleukins - blood ; Klinisk medicin ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Neurologi ; Neurology ; outcome ; subarachnoid haemorrhage ; Subarachnoid Hemorrhage - blood ; Subarachnoid Hemorrhage - complications ; Subarachnoid Hemorrhage - pathology
    ISSN: 0001-6314
    ISSN: 1600-0404
    E-ISSN: 1600-0404
    Source: Hellenic Academic Libraries Link
    Source: Academic Search Ultimate
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  • 5
    Language: English
    In: Scandinavian journal of trauma, resuscitation and emergency medicine, 2021-07-17, Vol.29 (1), p.94-94
    Description: Abstract Background Traumatic brain injuries (TBI) are associated with high risk of morbidity and mortality. Early outcome prediction in patients with TBI require reliable data input and stable prognostic models. The aim of this investigation was to analyze different CT classification systems and prognostic calculators in a representative population of TBI-patients, with known outcomes, in a neurointensive care unit (NICU), to identify the most suitable CT scoring system for continued research. Materials and methods We retrospectively included 158 consecutive patients with TBI admitted to the NICU at a level 1 trauma center in Sweden from 2012 to 2016. Baseline data on admission was recorded, CT scans were reviewed, and patient outcome one year after trauma was assessed according to Glasgow Outcome Scale (GOS). The Marshall classification, Rotterdam scoring system, Helsinki CT score and Stockholm CT score were tested, in addition to the IMPACT and CRASH prognostic calculators. The results were then compared with the actual outcomes. Results Glasgow Coma Scale score on admission was 3–8 in 38%, 9–13 in 27.2%, and 14–15 in 34.8% of the patients. GOS after one year showed good recovery in 15.8%, moderate disability in 27.2%, severe disability in 24.7%, vegetative state in 1.3% and death in 29.7%. When adding the variables from the IMPACT base model to the CT scoring systems, the Stockholm CT score yielded the strongest relationship to actual outcome. The results from the prognostic calculators IMPACT and CRASH were divided into two subgroups of mortality (percentages); ≤50% (favorable outcome) and 〉 50% (unfavorable outcome). This yielded favorable IMPACT and CRASH scores in 54.4 and 38.0% respectively. Conclusion The Stockholm CT score and the Helsinki score yielded the closest relationship between the models and the actual outcomes in this consecutive patient series, representative of a NICU TBI-population. Furthermore, the Stockholm CT score yielded the strongest overall relationship when adding variables from the IMPACT base model and would be our method of choice for continued research when using any of the current available CT score models.
    Subject(s): Analysis ; Brain ; CRASH score ; CT imaging ; Diagnostic imaging ; Emergency medical services ; Finland ; Helsinki CT score ; IMPACT score ; Injuries ; Marshall classification ; Mortality ; Netherlands ; Neurosciences ; Neurovetenskaper ; Original Research ; Rotterdam scoring system ; Stockholm CT score ; Sweden ; Traumatic brain injury
    ISSN: 1757-7241
    E-ISSN: 1757-7241
    Source: BioMedCentral Open Access
    Source: PubMed Central
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 6
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2021-09, Vol.65 (8), p.1102-1108
    Description: Background There is increasing evidence that the individual physician is the main factor influencing variability in end‐of‐life decision‐making in intensive care units. End‐of‐life decisions are complex and should be adapted to each patient. Physician‐related variability is problematic as it may result in unequal assessments that affect patient outcomes. The primary aim of this study was to investigate factors contributing to physician‐related variability in end‐of‐life decision‐making. Method This is a qualitative substudy of a previously conducted study. In‐depth thematic analysis of semistructured interviews with 19 critical care specialists from five different Swedish intensive care units was performed. Interviews took place between 1 February 2017 and 31 May 2017. Results Factors influencing physician‐related variability consisted of different assessment of patient preferences, as well as intensivists' personality and values. Personality was expressed mainly through pace and determination in the decision‐making process. Personal prejudices appeared in decisions, but few respondents had personally witnessed this. Avoidance of criticism and conflicts as well as individual strategies for emotional coping were other factors that influenced physician‐related variability. Many respondents feared criticism for making their assessments, and the challenging nature of end‐of‐life decision‐making lead to avoidance as well as emotional stress. Conclusion Variability in end‐of‐life decision‐making is an important topic that needs further investigation. It is imperative that such variability be acknowledged and addressed in a more formal and transparent manner. The ethical issues faced by intensivists have recently been compounded by the devastating impact of the COVID‐19 pandemic, demonstrating in profound terms the importance of the topic.
    Subject(s): Analysis ; Anestesi och intensivvård ; Anesthesiology ; Anesthesiology and Intensive Care ; critical care ; Decision-making ; difficulties ; end‐ ; end‐of‐life decision‐making ; health-care ; intensive care units ; life decision‐ ; making ; of‐ ; Physicians ; qualitative research ; Stress (Psychology) ; sustaining ; thematic analysis ; treatment ; units ; variability ; withdrawal ; withdrawal of life‐ ; withdrawal of life‐sustaining treatment
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Hellenic Academic Libraries Link
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  • 7
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2006-08, Vol.50 (7), p.833-839
    Description: Background:  Morbidly obese patients have an increased risk for peri-operative lung complications and develop a decrease in functional residual capacity (FRC). Electric impedance tomography (EIT) can be used for continuous, fast-response measurement of lung volume changes. This method was used to optimize positive end-expiratory pressure (PEEP) to maintain FRC. Methods:  Fifteen patients with a body mass index of 49 ± 8 kg/m2 were studied during anaesthesia for laparoscopic gastric bypass surgery. Before induction, 16 electrodes were placed around the thorax to monitor ventilation-induced impedance changes. Calibration of the electric impedance tomograph against lung volume changes was made by increasing the tidal volume in steps of 200 ml. PEEP was titrated stepwise to maintain a horizontal baseline of the EIT curve, corresponding to a stable FRC. Absolute FRC was measured with a nitrogen wash-out/wash-in technique. Cardiac output was measured with an oesophageal Doppler method. Volume expanders, 1 ± 0.5 l, were given to prevent PEEP-induced haemodynamic impairment. Results:  Impedance changes closely followed tidal volume changes (R2 〉 0.95). The optimal PEEP level was 15 ± 1 cmH2O, and FRC at this PEEP level was 1706 ± 447 ml before and 2210 ± 540 ml after surgery (P 〈 0.01). The cardiac index increased significantly from 2.6 ± 0.5 before to 3.1 ± 0.8 l/min/m2 after surgery, and the alveolar dead space decreased. PaO2/FiO2, shunt and compliance remained unchanged. Conclusion:  EIT enables rapid assessment of lung volume changes in morbidly obese patients, and optimization of PEEP. High PEEP levels need to be used to maintain a normal FRC and to minimize shunt. Volume loading prevents circulatory depression in spite of a high PEEP level.
    Subject(s): Adult ; Anestesi och intensivvård ; Anesthesia ; Anesthesia, General ; Anesthesiology and Intensive Care ; body mass index ; Cardiac Output ; Electric Impedance ; electric impedance tomography ; Female ; Functional Residual Capacity ; Gastric Bypass ; General ; Humans ; Laparoscopy ; Lung Compliance ; Lung Volume Measurements ; Male ; methods ; Middle Aged ; monitoring ; Morbid ; Obesity ; Obesity, Morbid - physiopathology ; Obesity, Morbid - surgery ; physiopathology ; positive end-expiratory pressure ; Positive-Pressure Respiration ; Positive-Pressure Respiration - methods ; Pulmonary Gas Exchange ; Surgery ; Tomography ; Usage
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Hellenic Academic Libraries Link
    Source: Academic Search Ultimate
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  • 8
    Language: English
    In: PloS one, 2014, Vol.9 (8), p.e103850-e103850
    Description: Evidence for the current guidelines for the treatment of patients with chronic total occlusions (CTO) in coronary arteries is limited. In this study we identified all CTO patients registered in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and studied the prevalence, patient characteristics and treatment decisions for CTO in Sweden. Between January 2005 and January 2012, 276,931 procedures (coronary angiography or percutaneous coronary intervention) were performed in 215,836 patients registered in SCAAR. We identified all patients who had 100% luminal diameter stenosis known or assumed to be ≥ 3 months old. After exclusion of patients with previous coronary artery bypass graft (CABG) surgery or coronary occlusions due to acute coronary syndrome, we identified 16,818 CTO patients. A CTO was present in 10.9% of all coronary angiographies and in 16.0% of patients with coronary artery disease. The majority of CTO patients were treated conservatively and PCI of CTO accounted for only 5.8% of all PCI procedures. CTO patients with diabetes and multivessel disease were more likely to be referred to CABG. CTO is a common finding in Swedish patients undergoing coronary angiography but the number of CTO procedures in Sweden is low. Patients with CTO are a high-risk subgroup of patients with coronary artery disease. SCAAR has the largest register of CTO patients and therefore may be valuable for studies of clinical importance of CTO and optimal treatment for CTO patients
    Subject(s): Acute coronary syndromes ; Aged ; Angiography ; Angioplasty ; Arteries ; Cardiac and Cardiovascular Systems ; Cardiology ; Cardiovascular disease ; Clinical Medicine ; Coronary Angiography ; Coronary artery ; Coronary Artery Bypass ; Coronary artery disease ; Coronary Occlusion - epidemiology ; Coronary Occlusion - therapy ; Coronary vessels ; Diabetes mellitus ; Ethics ; Female ; Heart ; Heart diseases ; Humans ; Intubation ; Kardiologi ; Klinisk medicin ; Male ; Medical and Health Sciences ; Medical imaging ; Medicin och hälsovetenskap ; Medicine and Health Sciences ; Methods ; Middle Aged ; Occlusions ; Patients ; Percutaneous Coronary Intervention ; Prevalence ; Registries ; Reproducibility of Results ; Review boards ; Risk Factors ; Risk groups ; Stenosis ; Stents ; Studies ; Subgroups ; Surgery ; Sweden - epidemiology ; Systematic review ; Task forces
    ISSN: 1932-6203
    E-ISSN: 1932-6203
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: SWEPUB Freely available online
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 9
    Language: English
    In: Acta neurologica Scandinavica, 2021-10-22
    Description: OBJECTIVESApproximately 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) develop delayed cerebral ischemia (DCI). DCI is associated with increased mortality and persistent neurological deficits. This study aimed to analyze heart rate variability (HRV) data from patients with aSAH using machine learning to evaluate whether specific patterns could be found in patients developing DCI. MATERIAL & METHODSThis is an extended, in-depth analysis of all HRV data from a previous study wherein HRV data were collected prospectively from a cohort of 64 patients with aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, from 2015 to 2016. The method used for analyzing HRV is based on several data processing steps combined with the random forest supervised machine learning algorithm. RESULTSHRV data were available in 55 patients, but since data quality was significantly low in 19 patients, these were excluded. Twelve patients developed DCI. The machine learning process identified 71% of all DCI cases. However, the results also demonstrated a tendency to identify DCI in non-DCI patients, resulting in a specificity of 57%. CONCLUSIONSThese data suggest that machine learning applied to HRV data might help identify patients with DCI in the future; however, whereas the sensitivity in the present study was acceptable, the specificity was low. Possible confounders such as severity of illness and therapy may have affected the result. Future studies should focus on developing a robust method for detecting DCI using real-time HRV data and explore the limits of this technology in terms of its reliability and accuracy.
    Subject(s): delayed cerebral ischemia ; heart rate variability ; machine learning ; Neurologi ; Neurology ; Neurosciences ; Neurosciences & Neurology ; Neurovetenskaper ; subarachnoid hemorrhage
    ISSN: 0001-6314
    E-ISSN: 1600-0404
    Source: Hellenic Academic Libraries Link
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  • 10
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2020-08, Vol.64 (7), p.945-952
    Description: Background Delayed cerebral ischemia (DCI) is a major cause of impaired outcome after aneurysmal subarachnoidal hemorrhage (aSAH). In this observational cohort study we investigated whether changes in heart rate variability (HRV) that precede DCI could be detected. Methods Sixty‐four patients with aSAH were included. HRV data were collected for up to 10 days and analyzed offline. Correlation with clinical status and/or radiologic findings was investigated. A linear mixed model was used for the evaluation of HRV parameters over time in patients with and without DCI. Extended Glasgow outcome scale score was assessed after 1 year. Results In 55 patients HRV data could be analyzed. Fifteen patients developed DCI. No changes in HRV parameters were observed 24 hours before onset of DCI. Mean of the HRV parameters in the first 48 hours did not correlate with the development of DCI. Low/high frequency (LF/HF) ratio increased more in patients developing DCI (β −0.07 (95% confidence interval, 0.12‐0.01); P = .012). Lower STDRR (standard deviation of RR intervals), RMSSD (root mean square of the successive differences between adjacent RR intervals), and total power (P = .003, P = .007 and P = .004 respectively) in the first 48 hours were seen in patients who died within 1 year. Conclusion Impaired HRV correlated with 1‐year mortality and LF/HF ratio increased more in patients developing DCI. Even though DCI could not be detected by the intermittent analysis of HRV used in this study, continuous HRV monitoring may have potential in the detection of DCI after aSAH using different methods of analysis.
    Subject(s): Anestesi och intensivvård ; Anesthesiology and Intensive Care
    ISSN: 0001-5172
    ISSN: 1399-6576
    E-ISSN: 1399-6576
    Source: Hellenic Academic Libraries Link
    Source: Academic Search Ultimate
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