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Haney, Michael
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Publications (10 of 72) Show all publications
Svenmarker, S., Hannuksela, M. & Haney, M. (2018). A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass. Perfusion, 33(6), 453-462
Open this publication in new window or tab >>A retrospective analysis of the mixed venous oxygen saturation as the target for systemic blood flow control during cardiopulmonary bypass
2018 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 6, p. 453-462Article in journal (Refereed) Published
Abstract [en]

Objectives: The patient's body surface area serves as the traditional reference for the determination of systemic blood flow during cardiopulmonary bypass (CPB). New strategies refer to different algorithms of oxygen delivery. This study reports on the mixed venous oxygen saturation (SvO2) as the target for systemic blood flow control. We hypothesise that an SvO2>75% (S(v)O(2)75) is associated with better preservation of renal function and improved short-term survival.

Methods: This retrospective, 10-year, observational study analysed 6945 consecutive cardiac surgical cases requiring CPB. Endpoints included rates of acute kidney injury (AKI) and short-term survival, also the estimated glomerular filtration rate ((e)GFR), lactate levels and blood transfusions.

Results: Seventy-seven percent of the patients attained the S(v)O(2)75 target. For this group, the median SvO2 was 78.1 (5.8) %, with a mean oxygen delivery of 331 (78) ml/min per m(2) body surface area. Overall incidence of AKI levels (I-III): 7.5% - 2.6% - 0.6%. Incidence of (e)GFR (<50%): 3.9%, increasing to 6% for haemoglobin levels <80 g/L (p<0.001). Red cell transfusion was more frequent (p<0.001) within this group (30.6%) compared to levels >100 g/L (0.3%). Further, women (52.8%) were transfused more often than men (14.6%). Lactate level at weaning from CPB was 1.3 (0.7) mmol/L. The S(v)O(2)75 target demonstrated a relative risk reduction of 22.5% (p=0.032) for AKI (I), increasing to 32.3% (p=0.026) for procedures extending >90 minutes. In addition, the risk for death 90-days postop was lower (p=0.039).

Conclusion: The S(v)O(2)75 target showed a decreased risk for postoperative AKI and prolonged short-term survival. Good clinical outcomes were also linked to measures of lactate and the (e)GFR. However, anaemia remains a risk factor for AKI.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
acute kidney injury, blood flow control, cardiopulmonary bypass, lactate, mixed venous oxygen saturation, survival
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-151546 (URN)10.1177/0267659118766437 (DOI)000442397500008 ()29623766 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-11Bibliographically approved
Moller, M. H., Granholm, A., Junttila, E., Haney, M., Oscarsson-Tibblin, A., Haavind, A., . . . Perner, A. (2018). Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure. Acta Anaesthesiologica Scandinavica, 62(4), 420-450
Open this publication in new window or tab >>Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 4, p. 420-450Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adult critically ill patients often suffer from acute circulatory failure and those with low cardiac output may be treated with inotropic agents. The aim of this Scandinavian Society of Anaesthesiology and Intensive Care Medicine guideline was to present patient-important treatment recommendations on this topic.

METHODS: This guideline was developed according to GRADE. We assessed the following subpopulations of patients with shock: (1) shock in general, (2) septic shock, (3) cardiogenic shock, (4) hypovolemic shock, (5) shock after cardiac surgery, and (6) other types of shock, including vasodilatory shock. We assessed patient-important outcome measures, including mortality and serious adverse reactions.

RESULTS: For all patients, we suggest against the routine use of any inotropic agent, including dobutamine, as compared to placebo/no treatment (very low quality of evidence). For patients with shock in general, and in those with septic and other types of shock, we suggest using dobutamine rather than levosimendan or epinephrine (very low quality of evidence). For patients with cardiogenic shock and in those with shock after cardiac surgery, we suggest using dobutamine rather than milrinone (very low quality of evidence). For the other clinical questions, we refrained from giving any recommendations or suggestions.

CONCLUSIONS: We suggest against the routine use of any inotropic agent in adult patients with shock. If used, we suggest using dobutamine rather than other inotropic agents for the majority of patients, however, the quality of evidence was very low, implying high uncertainty on the balance between the benefits and harms of inotropic agents.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
low cardiac output, decompensated heart failure, trial sequential analysis, septic shock, cardiogenic shock, levosimendan, dobutamine, surgery, metaanalysis, grade
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-145537 (URN)10.1111/aas.13089 (DOI)000426998600001 ()29479665 (PubMedID)1399-6576 (Electronic) 0001-5172 (Linking) (ISBN)
Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2018-06-09Bibliographically approved
Pischke, S. E., Haugaa, H. & Haney, M. (2017). A neglected organ in multiple organ failure - 'skin in the game'?. Acta Anaesthesiologica Scandinavica, 61(1), 5-7
Open this publication in new window or tab >>A neglected organ in multiple organ failure - 'skin in the game'?
2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1, p. 5-7Article in journal, Editorial material (Refereed) Published
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-133345 (URN)10.1111/aas.12823 (DOI)000394907900002 ()27918100 (PubMedID)1399-6576 (Electronic) 0001-5172 (Linking) (ISBN)
Note

Pischke, S E Haugaa, H Haney, M eng Editorial England 2016/12/06 06:00 Acta Anaesthesiol Scand. 2017 Jan;61(1):5-7. doi: 10.1111/aas.12823.

Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2018-06-09Bibliographically approved
Löfqvist, E., Oskarsson, Å., Brändström, H., Vuorio, A. & Haney, M. (2017). Evacuation preparedness in the event of fire in intensive care units in Sweden: more is needed. Prehospital and Disaster Medicine, 32(3), 317-320
Open this publication in new window or tab >>Evacuation preparedness in the event of fire in intensive care units in Sweden: more is needed
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2017 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 3, p. 317-320Article in journal (Refereed) Published
Abstract [en]

Introduction: Hospitals, including intensive care units (ICUs), can be subject to threat from fire and require urgent evacuation. Hypothesis: The hypothesis was that the current preparedness for ICU evacuation for fire in the national public hospital system in a wealthy country was very good, using Sweden as model. Methods: An already validated questionnaire for this purpose was adapted to national/local circumstances and translated into Swedish. It aimed to elicit information concerning fire response planning, personnel education, training, and exercises. Questionnaire results (yes/no answers) were collected and answers collated to assess grouped responses. Frequencies of responses were determined. Results: While a written hospital plan for fire response and evacuation was noted by all responders, personnel familiarity with the plan was less frequent. Deficiencies were reported concerning all categories: lack of written fire response plan for ICU, lack of personnel education in this, and lack of practical exercises to practice urgent evacuation in the event of fire. Conclusions: These findings were interpreted as an indication of risk for worse consequences for patients in the event of fire and ICU evacuation among the hospitals in the country that was assessed, despite clear regulations and requirements for these. The exact reasons for this lack of compliance with existing laws was not clear, though there are many possible explanations. To remedy this, more attention is needed concerning recognizing risk related to lack of preparedness. Where there exists a goal of high-quality work in the ICU, this should include general leadership and medical staff preparedness in the event of urgent ICU evacuation.

Place, publisher, year, edition, pages
Cambridge University Press, 2017
Keywords
ICU intensive care unit, fire preparedness, hospital evacuation, intensive care unit
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-132507 (URN)10.1017/S1049023X17000152 (DOI)000402845900014 ()28279230 (PubMedID)1945-1938 (Electronic) 1049-023X (Linking) (ISBN)
Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2018-06-09Bibliographically approved
Suominen, P. K. & Haney, M. F. (2017). Fast-tracking and extubation in paediatric cardiac surgery. Acta Anaesthesiologica Scandinavica, 61(8), 876-879
Open this publication in new window or tab >>Fast-tracking and extubation in paediatric cardiac surgery
2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 876-879Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-138574 (URN)10.1111/aas.12944 (DOI)000407231100002 ()
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2018-06-09Bibliographically approved
Brändström, H., Sundelin, A., Hoseason, D., Sundström, N., Birgander, R., Johansson, G., . . . Haney, M. (2017). Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25, Article ID 50.
Open this publication in new window or tab >>Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation
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2017 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, article id 50Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. METHODS: A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. RESULTS: Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. CONCLUSIONS: Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Air ambulance, Intracranial pressure, Pneumocephalus
National Category
Anesthesiology and Intensive Care Neurosciences Surgery Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-134974 (URN)10.1186/s13049-017-0394-9 (DOI)000401225800001 ()28499454 (PubMedID)
Available from: 2017-05-15 Created: 2017-05-15 Last updated: 2018-06-09Bibliographically approved
Myers, J. A., Powell, D. M., Aldington, S., Sim, D., Psirides, A., Hathaway, K. & Haney, M. F. (2017). The impact of fatigue on the non-technical skills performance of critical care air ambulance clinicians. Acta Anaesthesiologica Scandinavica, 61(10), 1305-1313
Open this publication in new window or tab >>The impact of fatigue on the non-technical skills performance of critical care air ambulance clinicians
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 10, p. 1305-1313Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue.

METHODS: Nineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants' fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance.

RESULTS: The main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2-3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states.

CONCLUSION: Non-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer.

Place, publisher, year, edition, pages
Hoboken: Wiley-Blackwell, 2017
Keywords
patient safety, operating theater, sleep, anesthesiologists, anesthetists, simulation, physician, errors, crises, scale
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-139553 (URN)10.1111/aas.12994 (DOI)000412533500009 ()1399-6576 (Electronic) 0001-5172 (Linking) (ISBN)
Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2018-06-09Bibliographically approved
Svennerholm, K., Rodsand, P., Hellman, U., Waldenström, A., Lundholm, M., Ahrén, D., . . . Haney, M. (2016). DNA content in extracellular vesicles isolated from porcine coronary venous blood directly after myocardial ischemic preconditioning. PLoS ONE, 11(7), Article ID e0159105.
Open this publication in new window or tab >>DNA content in extracellular vesicles isolated from porcine coronary venous blood directly after myocardial ischemic preconditioning
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 7, article id e0159105Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Extracellular vesicles (EV) are nano-sized membranous structures released from most cells. They have the capacity to carry bioactive molecules and gene expression signals between cells, thus mediating intercellular communication. It is believed that EV confer protection after ischemic preconditioning (IPC). We hypothesize that myocardial ischemic preconditioning will lead to rapid alteration of EV DNA content in EV collected from coronary venous effluent.

MATERIALS AND METHODS: In a porcine myocardial ischemic preconditioning model, EV were isolated from coronary venous blood before and after IPC by differential centrifugation steps culminating in preparative ultracentrifugation combined with density gradient ultracentrifugation. The EV preparation was validated, the DNA was extracted and further characterized by DNA sequencing followed by bioinformatics analysis.

RESULTS: Porcine genomic DNA fragments representing each chromosome, including mitochondrial DNA sequences, were detected in EV isolated before and after IPC. There was no difference detected in the number of sequenced gene fragments (reads) or in the genomic coverage of the sequenced DNA fragments in EV isolated before and after IPC. Gene ontology analysis showed an enrichment of genes coding for ion channels, enzymes and proteins for basal metabolism and vesicle biogenesis and specific cardiac proteins.

CONCLUSIONS: This study demonstrates that porcine EV isolated from coronary venous blood plasma contain fragments of DNA from the entire genome, including the mitochondria. In this model we did not find specific qualitative or quantitative changes of the DNA content in EV collected immediately after an in vivo myocardial IPC provocation. This does not rule out the possibility that EV DNA content changes in response to myocardial IPC which could occur in a later time frame.

Place, publisher, year, edition, pages
Public Libray Science, 2016
National Category
Cell and Molecular Biology
Identifiers
urn:nbn:se:umu:diva-124283 (URN)10.1371/journal.pone.0159105 (DOI)000380169600033 ()27434143 (PubMedID)
Available from: 2016-08-01 Created: 2016-08-01 Last updated: 2018-06-07Bibliographically approved
Axelsson, B., Häggmark, S., Svenmarker, S., Johansson, G., Gupta, A., Tyden, H., . . . Haney, M. (2016). Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model. Journal of Cardiovascular Pharmacology and Therapeutics, 21(5), 495-503
Open this publication in new window or tab >>Effects of Combined Milrinone and Levosimendan Treatment on Systolic and Diastolic Function During Postischemic Myocardial Dysfunction in a Porcine Model
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2016 (English)In: Journal of Cardiovascular Pharmacology and Therapeutics, ISSN 1074-2484, E-ISSN 1940-4034, Vol. 21, no 5, p. 495-503Article in journal (Refereed) Published
Abstract [en]

It is not known whether there are positive or negative interactions on ventricular function when a calcium-sensitizing inotrope is added to a phosphodiesterase inhibitor in the clinical setting of acute left ventricular (LV) dysfunction. We hypothesized that when levosimendan is added to milrinone treatment, there will be synergetic inotropic and lusitropic effects. This was tested in an anesthetized porcine postischemic global LV injury model, where ventricular pressures and volumes (conductance volumetry) were measured. A global ischemic injury was induced by repetitive left main stem coronary artery occlusions. Load-independent indices of LV function were assessed before and after ventricular injury, after milrinone treatment, and finally after addition of levosimendan to the milrinone treatment. Nonparametric, within-group comparisons were made. The protocol was completed in 12 pigs, 7 of which received the inotrope treatment and 5 of which served as controls. Milrinone led to positive lusitropic effects seen by improvement in tau after myocardial stunning. The addition of levosimendan to milrinone further increased lusitropic state. The latter effect could however not be attributed solely to levosimendan, since lusitropic state also improved spontaneously in time-matched controls at the same rate during the corresponding period. When levosimendan was added to milrinone infusion, there was no increase in systolic function (preload recruitable stroke work) compared to milrinone treatment alone. We conclude that in this model of postischemic LV dysfunction, there appears to be no clear improvement in systolic or diastolic function after addition of levosimendan to established milrinone treatment but also no negative effects of levosimendan in this context.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
cardiac pharmacology, cardioactive agents, experimental and clinical heart failure, ischemia-reperfusion injury
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-116180 (URN)10.1177/1074248416628675 (DOI)000382567800008 ()26837238 (PubMedID)1940-4034 (Electronic) 1074-2484 (Linking) (ISBN)
Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2018-06-07Bibliographically approved
Myers, J. A., Powell, D. M. C., Psirides, A., Hathaway, K., Aldington, S. & Haney, M. F. (2016). Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24, Article ID 24.
Open this publication in new window or tab >>Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study
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2016 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 24Article in journal (Refereed) Published
Abstract [en]

Background: In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment.

Methods: In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors.

Results: The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0.11) or observed non-technical skills performance (r(s) = 0.4, p = 0.1).

Discussion: This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance.

Conclusion: The AeroNOTS framework could be used to facilitate education and training in non-technical skills for air ambulance clinicians, and further evaluation of this rating system is merited.

Keywords
Non-technical skills, Air ambulance, Intensive care, Patient transport, Clinical training
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-118966 (URN)10.1186/s13049-016-0216-5 (DOI)000371592400001 ()26955943 (PubMedID)
Available from: 2016-05-03 Created: 2016-04-07 Last updated: 2018-06-07Bibliographically approved
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