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Brorsson, Camilla
Publications (8 of 8) Show all publications
Milton, A., Schandl, A., Soliman, I., Joelsson-Alm, E., van den Boogaard, M., Wallin, E., . . . Sackey, P. (2020). ICU discharge screening for prediction of new-onset physical disability: A multinational cohort study. Acta Anaesthesiologica Scandinavica
Open this publication in new window or tab >>ICU discharge screening for prediction of new-onset physical disability: A multinational cohort study
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2020 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new‐onset physical disability at ICU discharge.

Methods: Multinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new‐onset physical disability 3 months post‐ICU, defined as a ≥10 score reduction in the Barthel Index (BI) compared to baseline.

Results: Of the 572 included patients, follow‐up data are available on 78% of patients alive at follow‐up. The incidence of new‐onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81‐0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61‐0.76). Negative predictive value for a low‐risk group (CPAx score >18) was 0.88, and positive predictive value for a high‐risk group (CPAx score ≤18) was 0.32.

Conclusion: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post‐ICU. For high‐risk patients, research to determine post‐ICU risk factors for an incomplete rehabilitation is mandated.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2020
Keywords
activities of daily living, complications, critical care, decision support techniques, intensive care unit, rehabilitation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-169116 (URN)10.1111/aas.13563 (DOI)000516886000001 ()32083323 (PubMedID)
Available from: 2020-03-24 Created: 2020-03-24 Last updated: 2020-03-24
Milton, A., Schandl, A., Soliman, I. W., Meijers, K., van den Boogaard, M., Larsson, I. M., . . . Sackey, P. V. (2018). Development of an ICU discharge instrument predicting psychological morbidity: a multinational study. Intensive Care Medicine, 44(12), 2038-2047
Open this publication in new window or tab >>Development of an ICU discharge instrument predicting psychological morbidity: a multinational study
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2018 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, no 12, p. 2038-2047Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.

METHODS: Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥ 12 h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3 months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score ≥ 11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score > 45.

RESULTS: A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65 years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81).

CONCLUSIONS: We developed an instrument to predict individual patients' risk for psychological problems 3 months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/ . The instrument can be used for triage of patients for psychological ICU follow-up.

TRIAL REGISTRATION: The study was registered at clinicaltrials.gov, NCT02679157.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Anxiety, Depression, Follow-up, Intensive care, PICS, Post-traumatic stress
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-154009 (URN)10.1007/s00134-018-5467-3 (DOI)000452162900002 ()30467678 (PubMedID)
Funder
Västerbotten County Council
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2019-04-25Bibliographically approved
Koskinen, L.-O., Sundstrom, N., Brorsson, C. & Olivecrona, M. (2016). SECONDARY PEAK OF S-100B IS ASSOCIATED WITH DECOMPRESSIVE HEMICRANIECTOMY. Paper presented at 12th Symposium of the International-Neurotrauma-Society, FEB 01-04, 2016, Cape Town, SOUTH AFRICA. Journal of Neurotrauma, 33(3), A27-A27
Open this publication in new window or tab >>SECONDARY PEAK OF S-100B IS ASSOCIATED WITH DECOMPRESSIVE HEMICRANIECTOMY
2016 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 33, no 3, p. A27-A27Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

S-100B is a tissue biomarker for brain injury and secondary peak of S-100B (SP) is associated with outcome. Little is known whether SP is associated with decompressive hemicraniectomy (DC).

Keywords
S100 Proteins, biomarkers, brain injuries
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-118800 (URN)000369513600078 ()
Conference
12th Symposium of the International-Neurotrauma-Society, FEB 01-04, 2016, Cape Town, SOUTH AFRICA
Available from: 2016-04-22 Created: 2016-04-04 Last updated: 2019-11-25Bibliographically approved
Brorsson, C., Dahlqvist, P., Nilsson, L., Thunberg, J., Sylvan, A. & Naredi, S. (2014). Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs. Injury, 45(8), 1149-1155
Open this publication in new window or tab >>Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs
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2014 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 45, no 8, p. 1149-1155Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The adrenal response in critically ill patients, including trauma victims, has been debated over the last decade. The aim of this study was to assess the early adrenal response after trauma. METHODS: Prospective, observational study of 50 trauma patients admitted to a level-1-trauma centre. Serum and saliva cortisol were followed from the accident site up to five days after trauma. Corticosteroid binding globulin (CBG), dehydroepiandrosterone (DHEA) and sulphated dehydroepiandrosterone (DHEAS) were obtained twice during the first five days after trauma. The effect of time and associations between cortisol levels and; severity of trauma, infusion of sedative/analgesic drugs, cardiovascular dysfunction and other adrenocorticotropic hormone (ACTH) dependent hormones (DHEA/DHEAS) were studied. RESULTS: There was a significant decrease over time in serum cortisol both during the initial 24 h, and from the 2nd to the 5th morning after trauma. A significant decrease over time was also observed in calculated free cortisol, DHEA, and DHEAS. No significant association was found between an injury severity score >/= 16 (severe injury) and a low (< 200 nmol/L) serum cortisol at any time during the study period. The odds for a serum cortisol < 200 nmol/L was eight times higher in patients with continuous infusion of sedative/analgesic drugs compared to patients with no continuous infusion of sedative/analgesic drugs. CONCLUSION: Total serum cortisol, calculated free cortisol, DHEA and DHEAS decreased significantly over time after trauma. Continuous infusion of sedative/analgesic drugs was independently associated with serum cortisol < 200 nmol/L.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Multiple trauma, Adrenal insufficiency, Sedatives
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-91640 (URN)10.1016/j.injury.2014.02.001 (DOI)000340279500004 ()24975481 (PubMedID)1879-0267 (Electronic) 0020-1383 (Linking) (ISBN)
Available from: 2014-08-13 Created: 2014-08-13 Last updated: 2018-06-07Bibliographically approved
Brorsson, C., Dahlqvist, P., Nilsson, L. & Naredi, S. (2014). Saliva stimulation with glycerine and citric acid does not affect salivary cortisol levels. Clinical Endocrinology, 81(2), 244-248
Open this publication in new window or tab >>Saliva stimulation with glycerine and citric acid does not affect salivary cortisol levels
2014 (English)In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 81, no 2, p. 244-248Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

In critically ill patients with hypotension, who respond poorly to fluids and vasoactive drugs, cortisol insufficiency may be suspected. In serum over 90% of cortisol is protein-bound, thus routine measures of total serum cortisol may yield 'false lows' due to hypoproteinaemia. Thus, the occurrence of cortisol insufficiency could be overestimated in critically ill patients. Salivary cortisol can be used as a surrogate for free serum cortisol, but in critically ill patients saliva production is decreased, and insufficient volume of saliva for analysis is a common problem. The aim of this study was to investigate if a cotton-tipped applicator with glycerine and citric acid could be used for saliva stimulation without affecting salivary cortisol levels.

DESIGN:

Prospective, observational study.

PARTICIPANTS:

Thirty-six volunteers (six males, 30 females), age 49 ± 9 years, without known oral mucus membrane rupture in the mouth.

MEASUREMENTS:

Forty-two pairs of saliva samples (22 paired morning samples, 20 paired evening samples) were obtained before and after saliva stimulation with glycerine and citric acid. Salivary cortisol was analysed using Spectria Cortisol RIA (Orion Diagnostica, Finland).

RESULTS:

The paired samples correlated significantly (P < 0·0001) and there was no significant difference between un-stimulated and stimulated salivary cortisol levels.

CONCLUSIONS:

Saliva stimulation with a cotton-tipped applicator containing glycerine and citric acid did not significantly influence salivary cortisol levels in healthy volunteers. This indicates that salivary cortisol measurement after saliva stimulation may be a useful complement when evaluating cortisol status in critically ill patients.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-86808 (URN)10.1111/cen.12423 (DOI)000339670500013 ()24521305 (PubMedID)
Funder
Västerbotten County Council
Available from: 2014-03-11 Created: 2014-03-11 Last updated: 2019-03-06Bibliographically approved
Brorsson, C. (2014). Trauma - logistics and stress response. (Doctoral dissertation). Umeå Universitet
Open this publication in new window or tab >>Trauma - logistics and stress response
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Trauma is a major cause of death and disability. Adverse events, such as prolonged prehospital time, hypoxia, hypotension and/or hyperventilation have been reported to correlate to poor outcome.

Adequate cortisol levels are essential for survival after major trauma. In hypotensive critically ill patients, lack of sufficient amount of cortisol can be suspected, and a concept of critical illness related corticosteroid insufficiency has been proposed. Corticosteroid therapy has many adverse effects in critically ill patients and should only be given if life-saving. Correct measurement of serum cortisol levels is important but difficult in critically ill patients with capillary leakage. Estimation of the free and biologically active cortisol is preferable. In serum less than 10% of cortisol is free and biologically active and not possible to measure with routine laboratory methods. Salivary cortisol can be used as a surrogate for free cortisol, but salivary production is reduced in critically ill patients. Liver resection could reduce cortisol levels due to substrate deficiency.

Aims: 1. Evaluate the occurrence of early adverse events in patients with traumatic brain injury and relate them to outcome. 2. Assess cortisol levels over time after trauma and correlate to severity of trauma, sedative/analgesic drugs and cardiovascular function. 3. Evaluate if saliva stimulation could be performed without interfering with salivary cortisol levels. 4. Assess cortisol levels over time after liver resection in comparison to other major surgery.

Results: There was no significant correlation between prehospital time ³60 minutes, hypoxia (saturation <95%), hypotension (systolic blood pressure <90 mmHg), or hyperventilation (ETCO2 <4.5 kPa) and a poor outcome (Glasgow Outcome Scale 1-3) in patients with traumatic brain injury. Cortisol levels decreased significantly over time after trauma, but there was no correlation between low (<200 nmol/L) serum cortisol levels and severity of trauma.

Infusion of sedative/analgesic drugs was the strongest predictor for a low (<200 nmol/L) serum cortisol. The odds ratio for low serum cortisol levels (<200 nmol/L) was 8.0 for patients receiving continuous infusion of sedative/analgesic drugs. There was no significant difference between unstimulated and stimulated salivary cortisol levels (p=0.06) in healthy volunteers. Liver resection was not associated with significantly lower cortisol levels compared to other major surgery.

Conclusion: There was no significant correlation between early adverse events and outcome in patients with traumatic brain injury. Cortisol levels decreased significantly over time in trauma patients. Low cortisol levels (<200 nmol/L) were significantly correlated to continuous infusion of sedative/analgesic drugs. Saliva stimulation could be performed without interfering with salivary cortisol levels. Liver resection was not associated with low cortisol levels compared to other major surgery.

Place, publisher, year, edition, pages
Umeå Universitet, 2014. p. 65
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1654
Keywords
traumatic brain injury, multiple trauma, hydrocortisone, adrenal insufficiency, hypnotics and sedatives, citric acid, glycerol, saliva, liver, colorectal surgery
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-93324 (URN)978-91-7601-072-3 (ISBN)
Public defence
2014-10-10, E04 byggnad 6E NUS, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-09-19 Created: 2014-09-17 Last updated: 2018-06-07Bibliographically approved
Brorsson, C., Rodling-Wahlström, M., Olivecrona, M., Koskinen, L.-O. & Naredi, S. (2011). Severe traumatic brain injury: consequences of early adverse events. Acta Anaesthesiologica Scandinavica, 55(8), 944-951
Open this publication in new window or tab >>Severe traumatic brain injury: consequences of early adverse events
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2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 8, p. 944-951Article in journal (Refereed) Published
Abstract [en]

Background: Several factors associated with an unfavourable outcome after severe traumatic brain injury (TBI) have been described: prolonged pre-hospital time, secondary referral to a level 1 trauma centre, the occurrence of secondary insults such as hypoxia, hypotension or low end-tidal carbon dioxide (ETCO(2)). To determine whether adverse events were linked to outcome, patients with severe TBI were studied before arrival at a level 1 trauma centre.

Methods: Prospective, observational study design. Patients with severe TBI (n = 48), admitted to Umea University Hospital between January 2002 to December 2005 were included. All medical records from the site of the accident to arrival at the level 1 trauma centre were collected and evaluated.

Results: A pre-hospital time of >60 min, secondary referral to a level 1 trauma centre, documented hypoxia (oxygen saturation <95%), hypotension (systolic blood pressure <90 mmHg), hyperventilation (ETCO(2) <4.5 kPa) or tachycardia (heart rate >100 beats/min) at any time before arrival at a level 1 trauma centre were not significantly related to an unfavourable outcome (Glasgow Outcome Scale 1-3).

Conclusion: Early adverse events before arrival at a level 1 trauma centre were without significance for outcome after severe TBI in the trauma system studied.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-47379 (URN)10.1111/j.1399-6576.2011.02451.x (DOI)000294356500006 ()
Available from: 2011-09-26 Created: 2011-09-20 Last updated: 2019-11-28Bibliographically approved
Brorsson, C., Dahlqvist, P., Lundberg, O., Naredi, P. & Naredi, S. Liver resection is not associated with decreased cortisol levels..
Open this publication in new window or tab >>Liver resection is not associated with decreased cortisol levels.
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(English)Article in journal (Refereed) Submitted
Abstract [en]

Background: Adrenal hormones are synthesized from cholesterol, produced and stored in the liver. Liver failure has been reported to be associated with adrenal insufficiency. A possible mechanism could be a limited supply of substrate for cortisol synthesis. The aims of this study was to evaluate the occurrence of total serum cortisol <200 nmol/L after major liver resection (≥ 30%) and other major surgery (hemicolectomy) and to assess associations between cholesterol and corti­sol levels after liver resection.

Methods: Prospective, observational study. 40 patients were included (major liver resection n=15, hemicolectomy n=25). Serum and salivary cortisol were followed from morning before surgery up to five days postoperatively. Sulphated dehy­droepiandrosterone (DHEAS) and lipids (cholesterol, low density lipoproteins, high density lipoproteins and triglycerides) were obtained in liver resection patients.

Results: 8/25 (32%, hemicolectomy patients), and 3/15 (20%, liver resection patients) had serum cortisol <200 nmol/L. Neither hemicolectomy nor liver resec­tion was significantly associated with serum cortisol <200 nmol/L, p=0.49. Serum cortisol <200 nmol/L was not significantly associated with lipids below normal limits, (cholesterol; p=1.0 day 1, p=0.46 day 4, LDL; p=0.56 day 1, p=1.0 day 4, and HDL; p=0.27 day 1, p=1.0 day 4). Serum and salivary cortisol correlated sig­nificantly (rs=0.83, p<0.0001, hemicolectomy, rs=0.80, p<0.0001, liver resection).

Conclusion: Serum cortisol levels <200 nmol/L was found in 32% (hemicolec­tomy) and 20% (liver resection) postoperatively. Compared to after hemicolec­tomy, serum cortisol <200 nmol/L was not significantly more common after liver resection. Lipids below normal limits were not associated with serum cortisol <200 nmol/L after liver resection.

Key words: gastrointestinal surgical procedures, adrenal insufficiency, hydrocortisone

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-92170 (URN)
Available from: 2014-08-22 Created: 2014-08-22 Last updated: 2018-06-07
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