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Naredi, Silvana
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Sjöberg, R. L., Bergenheim, T., Mörén, L., Antti, H., Lindgren, C., Naredi, S. & Lindvall, P. (2015). Blood Metabolomic Predictors of 1-Year Outcome in Subarachnoid Hemorrhage. Neurocritical Care, 23(2), 225-232
Open this publication in new window or tab >>Blood Metabolomic Predictors of 1-Year Outcome in Subarachnoid Hemorrhage
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2015 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 23, no 2, p. 225-232Article in journal (Refereed) Published
Abstract [en]

Delayed neurological deficit (DND) is the most important cause of morbidity and mortality in patients with subarachnoid hemorrhage (SAH) whose aneurysms have been secured. However, the methods currently used to predict the development of DND, such as trans-cranial Doppler or levels biochemical markers in blood and cerebrospinal fluid are not very accurate. Venous blood was drawn from 50 patients with SAH, admitted to the neurosurgical department UmeAyen University Hospital, at day 1-3 and day 7 after the bleed. The clinical status of the patients was followed up approximately 1 year after this episode and classified according to the Glasgow Outcome Score (GOS). Results showed considerable differences in blood metabolomic patterns between day 1-3 and 7 after the hemorrhage. Fifty-six out of 98 metabolites could be identified from our in-house library and 17 of these metabolites changed significantly from day 1-3 to 7 after the bleed. One of these, myo-inositol, was predictive of clinical outcome even after correction for multiple testing. An estimation of the diagnostic accuracy of high levels of this substance in predicting good outcome (GOS 4-5) yielded a sensitivity of .763 and a specificity of .5 at the optimal cut off point. SAH is an event with a profound effect on blood metabolomics profiles. Myo-inositol might be an interesting compound for future study to focus on in the search for metabolic markers in venous blood of delayed neurological deterioration in SAH patients.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Delayed neurological deficit, Myo-inositol, Metabolomics, Subarachnoid hemorrhage, Vasospasm, nous blood
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-109362 (URN)10.1007/s12028-014-0089-2 (DOI)000360700700012 ()25667130 (PubMedID)
Available from: 2015-09-30 Created: 2015-09-25 Last updated: 2018-06-07Bibliographically approved
Lindgren, C., Hultin, M., Koskinen, L.-O. D., Lindvall, P., Borota, L. & Naredi, S. (2014). ADMA levels and arginine/ADMA ratios reflect severity of disease and extent of inflammation after subarachnoid hemorraghe. Neurocritical Care, 21(1), 91-101
Open this publication in new window or tab >>ADMA levels and arginine/ADMA ratios reflect severity of disease and extent of inflammation after subarachnoid hemorraghe
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2014 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 21, no 1, p. 91-101Article in journal (Refereed) Published
Abstract [en]

Background: Subarachnoid hemorrhage (SAH) is characterized by an inflammatory response that might induce endothelial dysfunction. The aim of this study was to evaluate if ADMA and arginine/ADMA ratios after SAH (indicators of endothelial dysfunction) are related to clinical parameters, inflammatory response, and outcome.

Methods: Prospective observational study. ADMA, arginine, C-reactive protein (CRP), and cytokines were obtained 0–240 h (h) after SAH. Definition of severe clinical condition was Hunt&Hess (H&H) 3–5 and less severe clinical condition H&H 1–2. Impaired cerebral circulation was assessed by clinical examination, transcranial doppler, CT-scan, and angiography. Glasgow outcome scale (GOS) evaluated the outcome.

Results: Compared to admission, 0–48 h after SAH, the following was observed 49–240 h after SAH; (a) ADMA was significantly increased at 97–240 h (highest 217–240 h), (b) CRP was significantly increased at 49–240 h (highest 73–96 h), (c) interleukin-6 (IL-6) was significantly lower at 97–240 h (highest 49–96 h), p < 0.05. ADMA, CRP, and IL-6 were significantly lower and peak arginine/ADMA ratio was significantly higher in patients with H&H 1–2 compared to patients with H&H 3–5, p < 0.05. The peak ADMA or the nadir arginine/ADMA ratio did not differ significantly between patients with (55 %) or without (45 %) signs of impaired cerebral circulation. The peak ADMA or the nadir arginine/ADMA ratio did not differ significantly between patients with GOS 1–3 and patients with GOS 4–5.

Conclusions: ADMA increased significantly after SAH, and the increase in ADMA started after the pro-inflammatory markers (CRP and IL-6) had peaked. This might indicate that endothelial dysfunction, with ADMA as a marker, is induced by a systemic inflammation.

Place, publisher, year, edition, pages
Humana Press, 2014
Keywords
ADMA, subarachnoid hemorrage, inflammation, interleukin
National Category
Anesthesiology and Intensive Care Neurosciences Neurology
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-87531 (URN)10.1007/s12028-013-9945-8 (DOI)000339350500014 ()24408146 (PubMedID)
Funder
Swedish Society for Medical Research (SSMF)
Available from: 2014-04-02 Created: 2014-04-02 Last updated: 2018-06-08Bibliographically 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
Rodling Wahlström, M., Olivecrona, M., Ahlm, C., Bengtsson, A., Koskinen, L.-O. D., Naredi, S. & Hultin, M. (2014). Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury: a randomised clinical study. SpringerPlus, 3, Article ID 98.
Open this publication in new window or tab >>Effects of prostacyclin on the early inflammatory response in patients with traumatic brain injury: a randomised clinical study
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2014 (English)In: SpringerPlus, E-ISSN 2193-1801, Vol. 3, article id 98Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE AND DESIGN: A prospective, randomised, double-blinded, clinical trial was performed at a level 1 trauma centre to determine if a prostacyclin analogue, epoprostenol (Flolan®), could attenuate systemic inflammatory response in patients with severe traumatic brain injury (TBI).

SUBJECTS: 46 patients with severe TBI, randomised to epoprostenol (n = 23) or placebo (n = 23).

TREATMENT: Epoprostenol, 0.5 ng · kg(-1) · min(-1), or placebo (saline) was given intravenously for 72 hours and then tapered off over the next 24 hours.

METHODS: Interleukin-6 (IL-6), interleukin-8 (IL-8), soluble intracellular adhesion molecule-1 (sICAM-1), C-reactive protein (CRP), and asymmetric dimethylarginine (ADMA) levels were measured over five days. Measurements were made at 24 h intervals ≤24 h after TBI to 97-120 h after TBI.

RESULTS: A significantly lower CRP level was detected in the epoprostenol group compared to the placebo group within 73-96 h (p = 0.04) and within 97-120 h (p = 0.008) after trauma. IL-6 within 73-96 h after TBI was significantly lower in the epoprostenol group compared to the placebo group (p = 0.04). ADMA was significantly increased within 49-72 h and remained elevated, but there was no effect of epoprostenol on ADMA levels. No significant differences between the epoprostenol and placebo groups were detected for IL-8 or sICAM-1.

CONCLUSIONS: Administration of the prostacyclin analogue epoprostenol significantly decreased CRP and, to some extent, IL-6 levels in patients with severe TBI compared to placebo. These findings indicate an interesting option for treatment of TBI and warrants future larger studies.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT01363583.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Traumatic brain injury, Epoprostenol, Systemic inflammatory response, Cytokines, Asymmetric dimethylarginine
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-88003 (URN)10.1186/2193-1801-3-98 (DOI)000358950600004 ()24600548 (PubMedID)
Available from: 2014-04-18 Created: 2014-04-18 Last updated: 2018-06-08Bibliographically 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
Lindgren, C., Dahlqvist, P., Lindvall, P., Nilsson, L., Koskinen, L.-O. & Naredi, S. (2013). Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage. Acta Anaesthesiologica Scandinavica, 57(4), 452-460
Open this publication in new window or tab >>Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage
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2013 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 4, p. 452-460Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Subarachnoid haemorrhage (SAH) is a life-threatening condition that may be aggravated by acute pituitary damage and cortisol insufficiency. Robust diagnostic criteria for critical illness-related corticosteroid insufficiency (CIRCI) are lacking. The aim of this study was to assess the frequency of CIRCI in the acute phase (0-240 h) after SAH and to evaluate associations between cortisol levels and clinical parameters (sedation, circulatory failure, gender, age, severity of disease, treatment). CIRCI was defined as a single morning serum cortisol (mSC) < 200 nmol/L. The lower limit for calculated free cortisol (cFC) was set at < 22 nmol/L, and for saliva cortisol at < 7.7 nmol/L.

METHODS: Fifty patients were included. Serum/saliva cortisol and corticosteroid-binding globulin were obtained every second morning. A logistic regression model was used for multivariate analysis comparing cortisol levels with clinical parameters.

RESULTS: Of the patients, 21/50 (42%) had an mSC < 200 nmol/L and 30/50 (60%) had a cFC < 22 nmol/L. In patients with continuous intravenous sedation, the odds ratio for a mSC to be < 200 nmol/L was 18 times higher (95% confidence interval 4.2-85.0, P < 0.001), and the odds ratio for a cFC to be < 22 nmol/L was 2.4 times higher (95% confidence interval 1.2-4.7, P < 0.05) compared with patients with no continuous intravenous sedation.

CONCLUSIONS: Continuous intravenous sedation was significantly associated with cortisol values under defined limits (mSC < 200, cFC < 22 nmol/L). The possibility that sedating drugs per se may influence cortisol levels should be taken into consideration before CIRCI is diagnosed.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-64100 (URN)10.1111/aas.12014 (DOI)000316138800006 ()23167448 (PubMedID)
Available from: 2013-01-15 Created: 2013-01-15 Last updated: 2018-06-08Bibliographically approved
Olofsson, A. D., Pettersson, F., Ljungberg, C., Hultin, M. & Naredi, S. (2013). The implementation of distance teaching in the Swedish Regionalized Medical Program - multiple small steps of change for an inert system. In: AMEE (Ed.), Book of Abstracts of the 40th AMEE-conference: Colouring outside the lines. Paper presented at 40th AMEE-conference, 24-28 August 2013, Prague, Czech Republic. (pp. 329-329). Prague
Open this publication in new window or tab >>The implementation of distance teaching in the Swedish Regionalized Medical Program - multiple small steps of change for an inert system
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2013 (English)In: Book of Abstracts of the 40th AMEE-conference: Colouring outside the lines / [ed] AMEE, Prague, 2013, p. 329-329Conference paper, Published paper (Refereed)
Abstract [en]

Background: This study examines possibilities and challenges when implementing distance teaching for teaching theoretical content in the Swedish regionalized medical program (RMP). The distance teaching by means of digital technologies and Technology-Enhanced Learning (TEL) is seen as an alternative to the face-to-face teaching in the medical program. Summary of work: A framework built upon the work of Sannino (2008) including the notion of dominant and non-dominant activities, conflicts and transitional actions were used for analysis. Summary of results: In the results a number of conflicts were identified which inhibit medical teachers from adopting especially interactive and communicative elements of distance teaching. Those were for example teachers’ digital literacy, lack of trust in digital teaching tools and willingness to keep to the face-to-face teaching practice. Conclusions: Illustrated by transitional actions it is discussed how the non-dominant distance teaching activity actually functioned as a catalyst for minor but important changes in the medical teachers’ dominant face-to-face teaching practice. Based on the results from this study one can raise the question of what really can be seen as a success or a failure when implementing TEL in medical education. Implementation processes in medical education is a process of interplay between dominant and non-dominant activities. Recognizing such interplay provides possibilities for future educational development. Take-home messages: Implementing distance teaching is not a straightforward process but rather characterized by small steps of change that needs to be continuously supported by the medical program management.

Place, publisher, year, edition, pages
Prague: , 2013
National Category
Pedagogy
Identifiers
urn:nbn:se:umu:diva-81361 (URN)
Conference
40th AMEE-conference, 24-28 August 2013, Prague, Czech Republic.
Available from: 2013-10-08 Created: 2013-10-08 Last updated: 2018-06-08Bibliographically approved
Fjellström, M., Naredi, S., Sawert, B. & Johnson, O. (2012). En bro mellan högre utbildning och profession: Utbildning för kliniska handledare i läkarutbildning. In: Nu 2012 Göteborg 17-19 oktober 2012: Gränslöst lärande. Paper presented at Nu 2012 Göteborg 17-19 oktober 2012 (pp. 131-132). Göteborg
Open this publication in new window or tab >>En bro mellan högre utbildning och profession: Utbildning för kliniska handledare i läkarutbildning
2012 (Swedish)In: Nu 2012 Göteborg 17-19 oktober 2012: Gränslöst lärande, Göteborg, 2012, p. 131-132Conference paper, Oral presentation with published abstract (Refereed)
Abstract [sv]

I samband med att läkarutbildningen vid Umeå universitet skulle regionaliseras togs beslut om att samtliga kliniska handledare, varav flertalet är landstingsanställda läkare, i regionen (Västerbotten, Norrbotten, Jämtland och Västernorrland) skulle erbjudas handledarutbildning. Utbildningen skulle stärka kopplingen mellan de högskoleförlagda och de verksamhetsförlagda delarna av utbildningen samt stödja en handledarroll starkt utmanad av sjukvårdens verksamhetskrav.  Läkarutbildningen har utökats kraftigt de senaste femton åren samtidigt som kraven ökat på produktivitet inom hälso- och sjukvården. Resultatet har blivit många studenter ute i klinisk verksamhet med kliniska handledare som ofta varken har en tydlig rolldefinition som handledare, aktuell kunskap om vilka mål som skall uppnås eller redskap för hur handledning skall genomföras i en splittrad och tidspressad vardag. För studenterna har problemen yttrat sig i form av brist på tid med, eller avsaknad av, handledare och sämre möjligheter att fullfölja praktiska utbildningsmoment (Läkartidningen, 2008:38; MSF Handledningsenkät 2011). Socialstyrelsen har också uppmärksammat behovet av handledarutbildning genom att ställa krav på handledarutbildning för handledare i specialiseringstjänstgöring (ST) för läkare (SOSFS 2008:17, 3 kap).

Fokus för handledarutbildningen blev att utveckla de kliniska handledarnas kunskaper om och förmåga att handleda i kliniska situationer samt att stimulera ett reflekterande och prövande förhållningssätt till studenternas lärande och den egna handledarrollen. Teman som ingår är: Mål och regelverk för läkarprogrammet, planering av klinisk handledning, att stödja ett reflekterat och handlingsinriktat lärande, att handleda, samtal, feedback och bedömning samt den professionella handledaren. Utbildningen, som genomförs som ett samarbete mellan universitetet och de fyra landstingen, omfattar tre dagar med ett eget arbete som genomförs av deltagarna mellan kursdag 2 och 3. Sedan 2009 har 177 kliniska handledare utbildats. Utvärderingar genomförda i samband med kursens genomförande har visat att de kliniska handledarna genomgående är mycket positiva till utbildningen. Det som särskilt lyfts fram är möjligheten till egen reflektion, praktisk problemlösning tillsammans med andra handledare samt en starkare koppling till utbildningsuppdraget genom den ökade kunskapen om lärande och högskolans regelverk.

Under den period som handledarutbildningen genomförts har intresset väckts för att handledarutbildning för kliniska handledare skall genomföras i två steg. Ett inledande steg fokuserat på grundläggande handledarkunskap och handledning inom läkarprogrammet som skulle genomföras under läkares specialiseringstjänstgöring. Dessutom ett senare steg, riktat till färdiga specialistkompetenta läkare, som fokuserar på den mer långsiktiga och individnära handledning som genomförs under specialisttjänstgöringen. Idag för läkarprogrammet vid Umeå universitet samtal med två landsting i regionen om möjligheten att bedriva den grundläggande handledarutbildningen.

Place, publisher, year, edition, pages
Göteborg: , 2012
Keywords
Klinisk handledning; Handledarutbildning; Läkarutbildning
National Category
Pedagogy
Research subject
Education
Identifiers
urn:nbn:se:umu:diva-66303 (URN)
Conference
Nu 2012 Göteborg 17-19 oktober 2012
Available from: 2013-02-18 Created: 2013-02-18 Last updated: 2018-06-08Bibliographically approved
Lindgren, C., Nordh, E., Naredi, S. & Olivecrona, M. (2012). Frequency of non-convulsive Seizures and non-convulsive status Epilepticus in Subarachnoid Hemorrhage patients in need of controlled ventilation and sedation. Neurocritical Care, 17(3), 367-373
Open this publication in new window or tab >>Frequency of non-convulsive Seizures and non-convulsive status Epilepticus in Subarachnoid Hemorrhage patients in need of controlled ventilation and sedation
2012 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 17, no 3, p. 367-373Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Non-convulsive seizures (NCSZ) can be more prevalent than previously recognized among comatose neuro-intensive care patients. The aim of this study was to evaluate the frequency of NCSZ and non-convulsive status epilepticus (NCSE) in sedated and ventilated subarachnoid hemorrhage (SAH) patients.

METHODS: Retrospective study at a university hospital neuro-intensive care unit, from January 2008 until June 2010. Patients were treated according to a local protocol, and were initially sedated with midazolam or propofol or combinations of these sedative agents. Thiopental was added for treatment of intracranial hypertension. No wake-up tests were performed. Using NicoletOne((R)) equipment (VIASYS Healthcare Inc., USA), continuous EEG recordings based on four electrodes and a reference electrode was inspected at full length both in a two electrode bipolar and a four-channel referential montage.

RESULTS: Approximately 5,500 h of continuous EEG were registered in 28 SAH patients (33 % of the patients eligible for inclusion). The median Glasgow Coma scale was 8 (range 3-14) and the median Hunt and Hess score was 4 (range 1-4). During EEG registration, no clinical seizures were observed. In none of the patients inter ictal epileptiform activity was seen. EEG seizures were recorded only in 2/28 (7 %) patients. One of the patients experienced 4 min of an NCSZ and one had a 5 h episode of an NCSE.

CONCLUSION: Continuous EEG monitoring is important in detecting NCSZ in sedated patients. Continuous sedation, without wake-up tests, was associated with a low frequency of subclinical seizures in SAH patients in need of controlled ventilation.

Place, publisher, year, edition, pages
Totowa, NJ, USA: Humana Press, 2012
Keywords
Epilepsy, Seizures, Non-convulsive seizures, Continuous electroencephalogram, Subarachnoid hemorrhage
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-59419 (URN)10.1007/s12028-012-9771-4 (DOI)1556-0961 (Electronic) 1541-6933 (Linking) (ISBN)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2018-06-08Bibliographically approved
Olivecrona, M., Rodling-Wahlstrom, M., Naredi, S. & Koskinen, L.-O. D. (2012). Prostacyclin treatment and clinical outcome in severe traumatic brain injury patients managed with an ICP-targeted therapy: A prospective study. Brain Injury, 26(1), 67-75
Open this publication in new window or tab >>Prostacyclin treatment and clinical outcome in severe traumatic brain injury patients managed with an ICP-targeted therapy: A prospective study
2012 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 26, no 1, p. 67-75Article in journal (Refereed) Published
Abstract [en]

Objective: To prospectively assess clinical outcome in patients with severe traumatic brain injury (sTBI) managed according to an ICP-targeted programme as well as additional treatment with prostacyclin.

Materials and methods: Inclusion criteria were GCS <= 8, age 15-70 years, first recorded cerebral perfusion pressure (CPP)>10mmHg. Exclusion criteria were pregnancy, breastfeeding or penetrating brain injury. The patients were treated using the same ICP-guided protocol, with one group randomized to receive prostacyclin in a low dose (0.5 ng kg(-1) min(-1)). The clinical outcome was prospectively assessed at 3, 6, 12, 18 and 24 months using structured interviews.

Results: Forty-eight patients were included, mean age 35.5 years, median GCS 6 (3-8), 69% were multi-traumatized. Mortality at 3 months was 12.5%. Median Glasgow Outcome Scale (GOS) at all follow-up points was 4. Favourable outcome (GOS 4-5) at 3 months was 52%, at 24 months 64%. Favourable outcome increased over time. There was a statistically significant association between GOS, GCS at admission and age. Higher ICP(max) was associated with worse outcome.

Conclusion: With this treatment protocol, a low number of deaths and a high number of favourable outcomes in sTBI were observed. Prostacyclin in this low dose does not seem to improve the outcome. ICP(max) is a positive predictor of worse outcome. Higher GCS at admission and lower age are correlated to better outcome.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2012
Keywords
Outcome, long-time, severe traumatic brain injury, ICP, prostacyclin
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-50918 (URN)10.3109/02699052.2011.635351 (DOI)000297787900007 ()
Available from: 2012-01-20 Created: 2012-01-02 Last updated: 2018-06-08Bibliographically approved
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