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Johansson, Joakim
Publications (10 of 20) Show all publications
Larsson, N., Nording, M. L., Tydén, J., Johansson, J., Lindberg, R. & Haney, M. (2023). Oxylipin profiles during the first day of mechanical ventilation in an intensive care unit cohort: research letter [Letter to the editor]. Anesthesiology, 138(5), 561-563
Open this publication in new window or tab >>Oxylipin profiles during the first day of mechanical ventilation in an intensive care unit cohort: research letter
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2023 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 138, no 5, p. 561-563Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-206880 (URN)10.1097/ALN.0000000000004518 (DOI)000989777900012 ()36857438 (PubMedID)2-s2.0-85152244324 (Scopus ID)
Available from: 2023-04-20 Created: 2023-04-20 Last updated: 2023-09-05Bibliographically approved
Ruge, T., Larsson, A., Lipcsey, M., Tydén, J., Johansson, J. & Eriksson, M. (2021). A comparison between endostatin and conventional biomarkers on 30-day mortality and renal replacement therapy in unselected intensive care patients. Biomedicines, 9(11), Article ID 1603.
Open this publication in new window or tab >>A comparison between endostatin and conventional biomarkers on 30-day mortality and renal replacement therapy in unselected intensive care patients
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2021 (English)In: Biomedicines, E-ISSN 2227-9059, Vol. 9, no 11, article id 1603Article in journal (Refereed) Published
Abstract [en]

Endostatin may predict mortality and kidney impairment in general populations as well as in critically ill patients. We decided to explore the possible role of endostatin as a predictor of 30-day mortality, acute kidney injury (AKI), and renal replacement therapy (RRT) in a cohort of unselected intensive care unit (ICU) patients. Endostatin and creatinine in plasma were analyzed and SAPS3 was determined in 278 patients on ICU arrival at admission to a Swedish medium-sized hospital. SAPS3 had the highest predictive value, 0.85 (95% C.I.: 0.8–0.90), for 30-day mortality. Endostatin, in combination with age, predicted 30-day mortality by 0.76 (95% C.I.: 0.70–0.82). Endostatin, together with age and creatinine, predicted AKI with 0.87 (95% C.I.: 0.83–0.91). Endostatin predicted AKI with [0.68 (0.62–0.74)]. Endostatin predicted RRT, either alone [0.82 (95% C.I.: 0.72–0.91)] or together with age [0.81 (95% C.I.: 0.71–0.91)]. The predicted risk for 30-day mortality, AKI, or RRT during the ICU stay, predicted by plasma endostatin, was not influenced by age. Compared to the complex severity score SAPS3, circulating endostatin, combined with age, offers an easily managed option to predict 30-day mortality. Additionally, circulating endostatin combined with creatinine was closely associated with AKI development.

Place, publisher, year, edition, pages
MDPI, 2021
Keywords
Acute kidney injury, Critical illness, Endostatin, Epidemiology, Intensive care unit, Mortality, Renal replacement therapy, SAPS3
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-190008 (URN)10.3390/biomedicines9111603 (DOI)000727277500001 ()2-s2.0-85119690971 (Scopus ID)
Available from: 2021-12-01 Created: 2021-12-01 Last updated: 2023-09-05Bibliographically approved
Grauman, S., Johansson, J. & Drevhammar, T. (2021). Large variations of oxygen delivery in self-inflating resuscitation bags used for preoxygenation - a mechanical simulation. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), Article ID 98.
Open this publication in new window or tab >>Large variations of oxygen delivery in self-inflating resuscitation bags used for preoxygenation - a mechanical simulation
2021 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 29, no 1, article id 98Article in journal (Refereed) Published
Abstract [en]

Background: Self-Inflating Resuscitation Bags (SIRB) are common and essential tools in airway management and ventilation. They are often used in resuscitation and emergency anaesthesia outside the operating theatre. There is a common notion that all SIRBs applied with a tight sealed mask will deliver close to 100 % oxygen during spontaneous breathing. The aim of the study was to measure the oxygen delivery of six commonly used SIRBs in a mechanical spontaneous breathing adult in vitro model.

Methods: Three SIRBs of each of the six models were evaluated for oxygen delivery during simulated breathing with an adult mechanical lung. The test was repeated three times per device (54 tests in total). The breathing profile was fixed to a minute volume of 10 L/min, a tidal volume of 500 mL and the SIRBs supplied with an oxygen fresh gas flow of 15 L/min. The fraction of delivered oxygen (FDO2) was measured over a three-minute period. Average FDO2 was calculated and compared at 30, 60 and 90 s.

Results: At 90 s all models had reached a stable FDO2. Average FDO2 at 90 s; Ambu Oval Plus 99,5 %; Ambu Spur II 99,8 %; Intersurgical BVM Resuscitator 76,7 %; Laerdal Silicone 97,3 %; Laerdal The Bag II 94,5 % and the O-Two Smart Bag 39,0 %. All differences in FDO2 were significant apart from the two Ambu models.

Conclusions: In simulated spontaneous breathing, four out of six (by Ambu and Laerdal) Self-Inflating Resuscitation Bags delivered a high fraction of oxygen while two (Intersurgical and O-two) underperformed in oxygen delivery. These large variations confirm results reported in other studies. It is our opinion that underperforming Self-Inflating Resuscitation Bags might pose a serious threat to patients’ health if used in resuscitation and anaesthesia. Manufacturers of Self-Inflating Resuscitation Bags rarely provide information on performance for spontaneous breathing. This poses a challenge to all organizations that need their devices to deliver adequate oxygen during spontaneous breathing.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
BVM, Emergency anaesthesia, Oxygen delivery, Preoxygenation, Self-inflating resuscitation bags
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-186436 (URN)10.1186/s13049-021-00885-3 (DOI)000675817900004 ()34281616 (PubMedID)2-s2.0-85110811811 (Scopus ID)
Funder
Swedish Heart Lung Foundation
Available from: 2021-08-02 Created: 2021-08-02 Last updated: 2024-01-17Bibliographically approved
Samuelsson, L., Tyden, J., Herwald, H., Hultin, M., Walldén, J., Steinvall, I., . . . Johansson, J. (2019). Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers. PLOS ONE, 14(8), Article ID e0221813.
Open this publication in new window or tab >>Renal clearance of heparin-binding protein and elimination during renal replacement therapy: Studies in ICU patients and healthy volunteers
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2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 8, article id e0221813Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Heparin-binding protein (HBP) is released by neutrophils upon activation, and elevated plasma levels are seen in inflammatory states like sepsis, shock, cardiac arrest, and burns. However, little is known about the elimination of HBP. We wanted to study renal clearance of HBP in healthy individuals and in burn patients in intensive care units (ICUs). We also wished to examine the levels of HBP in the effluent of renal replacement circuits in ICU patients undergoing continuous renal replacement therapy (CRRT).

METHODS: We measured plasma and urine levels of HBP and urine flow rate in 8 healthy individuals and 20 patients in a burn ICU. In 32 patients on CRRT, we measured levels of HBP in plasma and in the effluent of the CRRT circuit.

RESULTS: Renal clearance of HBP (median (IQR) ml/min) was 0.19 (0.08-0.33) in healthy individuals and 0.30 (0.01-1.04) in burn ICU patients. In ICU patients with cystatin C levels exceeding 1.44 mg/l, clearance was 0.45 (0.15-2.81), and in patients with cystatin C below 1.44 mg/l clearance was lower 0.28 (0.14-0.55) (p = 0.04). Starting CRRT did not significantly alter plasma levels of HBP (p = 0.14), and the median HBP level in the effluent on CRRT was 9.1 ng/ml (IQR 7.8-14.4 ng/ml).

CONCLUSION: In healthy individuals and critically ill burn patients, renal clearance of HBP is low. It is increased when renal function is impaired. Starting CRRT in critically ill patients does not alter plasma levels of HBP significantly, but HBP can be found in the effluent. It seems unlikely that impaired kidney function needs to be considered when interpreting concentrations of HBP in previous studies. Starting CRRT does not appear to be an effective way of reducing HBP concentrations.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-162913 (URN)10.1371/journal.pone.0221813 (DOI)000485058200055 ()31465432 (PubMedID)2-s2.0-85071497875 (Scopus ID)
Available from: 2019-09-02 Created: 2019-09-02 Last updated: 2024-07-02Bibliographically approved
Tydén, J., Larsson, N., Lehtipalo, S., Herwald, H., Hultin, M., Walldén, J., . . . Johansson, J. (2018). Heparin-binding protein in ventilator-induced lung injury.. Intensive Care Medicine Experimental, 6(1), Article ID 33.
Open this publication in new window or tab >>Heparin-binding protein in ventilator-induced lung injury.
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2018 (English)In: Intensive Care Medicine Experimental, E-ISSN 2197-425X, Vol. 6, no 1, article id 33Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although mechanical ventilation is often lifesaving, it can also cause injury to the lungs. The lung injury is caused by not only high pressure and mechanical forces but also by inflammatory processes that are not fully understood. Heparin-binding protein (HBP), released by activated granulocytes, has been indicated as a possible mediator of increased vascular permeability in the lung injury associated with trauma and sepsis. We investigated if HBP levels were increased in the bronchoalveolar lavage fluid (BALF) or plasma in a pig model of ventilator-induced lung injury (VILI). We also investigated if HBP was present in BALF from healthy volunteers and in intubated patients in the intensive care unit (ICU).

METHODS: Anaesthetized pigs were randomized to receive ventilation with either tidal volumes of 8 ml/kg (controls, n = 6) or 20 ml/kg (VILI group, n = 6). Plasma and BALF samples were taken at 0, 1, 2, 4, and 6 h. In humans, HBP levels in BALF were sampled from 16 healthy volunteers and from 10 intubated patients being cared for in the ICU.

RESULTS: Plasma levels of HBP did not differ between pigs in the control and VILI groups. The median HBP levels in BALF were higher in the VILI group after 6 h of ventilation compared to those in the controls (1144 ng/ml (IQR 359-1636 ng/ml) versus 89 ng/ml (IQR 33-191 ng/ml) ng/ml, respectively, p = 0.02). The median HBP level in BALF from healthy volunteers was 0.90 ng/ml (IQR 0.79-1.01 ng/ml) as compared to 1959 ng/ml (IQR 612-3306 ng/ml) from intubated ICU patients (p < 0.001).

CONCLUSIONS: In a model of VILI in pigs, levels of HBP in BALF increased over time compared to controls, while plasma levels did not differ between the two groups. HBP in BALF was high in intubated ICU patients in spite of the seemingly non-harmful ventilation, suggesting that inflammation from other causes might increase HBP levels.

Place, publisher, year, edition, pages
SpringerOpen, 2018
Keywords
HBP, Neutrophils, Pigs, Ventilator-induced lung injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-151814 (URN)10.1186/s40635-018-0198-x (DOI)000445485300001 ()30203380 (PubMedID)2-s2.0-85088034342 (Scopus ID)
Available from: 2018-09-13 Created: 2018-09-13 Last updated: 2024-07-02Bibliographically approved
Nelson, A., Johansson, J., Tydén, J. & Bodelsson, M. (2017). Circulating syndecans during critical illness. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 125(5), 468-475
Open this publication in new window or tab >>Circulating syndecans during critical illness
2017 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 125, no 5, p. 468-475Article in journal (Refereed) Published
Abstract [en]

Circulating syndecans are proposed to be markers of glycocalyx degradation and previous investigations have found higher plasma levels of syndecan-1 among patients with different pathological conditions. We wanted to investigate if levels of other syndecans (-2,-3 and -4) are altered during critical illness and compare the levels to syndecan-1. In 137 consecutive intensive care unit (ICU) patients with sepsis, cardiac arrest, gastrointestinal bleeding, intoxication or trauma, plasma levels of syndecan-1, -2, -3 and -4 were measured using ELISA. Syndecan-1 and syndecan-3 levels were similar among the different ICU patient groups but higher than controls. No differences in plasma levels of syndecan-2 or syndecan-4 were found neither among the different ICU patient groups nor compared to controls. All syndecans showed an association with mortality and the levels of syndecan-1 and -3 and correlated with each other. The results indicate that syndecan release is triggered by the physiological stress of critical illness in general and involves several subtypes such as syndecan-1 and syndecan-3.

Keywords
Syndecan, glycocalyx, critical illness
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-136342 (URN)10.1111/apm.12662 (DOI)000402174000006 ()28256016 (PubMedID)2-s2.0-85014165680 (Scopus ID)
Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2023-03-24Bibliographically approved
Tydén, J., Herwald, H., Hultin, M., Walldén, J. & Johansson, J. (2017). Heparin-binding protein as a biomarker of acute kidney injury in critical illness. Acta Anaesthesiologica Scandinavica, 61(7), 797-803
Open this publication in new window or tab >>Heparin-binding protein as a biomarker of acute kidney injury in critical illness
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 7, p. 797-803Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is no biomarker with high sensitivity and specificity for the development of acute kidney injury (AKI) in a mixed intensive care unit (ICU) population. Heparin-binding protein (HBP) is released from granulocytes and causes increased vascular permeability which plays a role in the development of AKI in sepsis and ischemia. The aim of this study was to investigate whether plasma levels of HBP on admission can predict the development of AKI in a mixed ICU population and in the subgroup with sepsis. METHODS: Longitudinal observational study with plasma HBP levels from 245 patients taken on admission to ICU. Presence and severity of AKI was scored daily for 1 week. RESULTS: Mean (95% CI) plasma concentrations of log HBP (ng/ml) in the groups developing different stages of AKI were: stage 0 (n = 175), 3.5 (3.4-3.7); stage 1 (n = 33), 3.7 (3.5-4.0), stage 2 (n = 20), 4.4 (3.5-4.8); and stage 3 (n = 17), 4.6 (3.8-5.2). HBP levels were significantly higher in patients developing AKI stage 3 (P < 0.01) compared to AKI stage 0 and 1. The area under the curve (AUC) for HBP to discriminate the group developing AKI stage 2-3 was 0.70 (CI: 0.58-0.82) and in the subgroup with severe sepsis 0.88 (CI: 0.77-0.99). CONCLUSION: Heparin-binding protein levels on admission to ICU are associated with the development of severe kidney injury. The relationship between HBP and AKI needs to be further validated in larger studies.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-136671 (URN)10.1111/aas.12913 (DOI)000404981100012 ()28585315 (PubMedID)2-s2.0-85021778493 (Scopus ID)
Available from: 2017-06-21 Created: 2017-06-21 Last updated: 2024-07-02Bibliographically approved
Johansson, J., Lindahl, M., Gyllencreutz, E. & Hahn, R. G. (2017). Symptomatic absorption of isotonic saline during transcervical endometrial resection. Acta Anaesthesiologica Scandinavica, 61(1), 121-124
Open this publication in new window or tab >>Symptomatic absorption of isotonic saline during transcervical endometrial resection
2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1, p. 121-124Article in journal (Refereed) Published
Abstract [en]

Absorption of irrigating fluid is a well-known complication of endoscopic surgeries, such as transurethral resection of the prostate and transcervical endometrial resection (TCER). Irrigating fluid is used to distend the hollow organ and allows the surgeon to visualize the operating field. Traditional monopolar diathermy requires irrigating fluid to be electrolyte free, which is unphysiological and therefore elicits various symptoms when absorbed.(1-4) In recent years, endoscopic resections have often been conducted with a bipolar resectoscope, which allows crystalloid fluid to be used for irrigation. The symptoms, hemodynamic effects, and biochemical changes that arise from rapid inadvertent overload of crystalloid fluid in clinical settings are not as well known as those due to overload of electrolyte-free fluid. Further, current guidelines may be interpreted as that 2500-ml resorption of saline could be accepted.(5) Therefore, we describe two patients who absorbed isotonic saline during TCERs performed under general anesthesia. The second one (case B) probably was further complicated by a venous gas embolus.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-133271 (URN)10.1111/aas.12834 (DOI)000394907900016 ()27918101 (PubMedID)2-s2.0-85000399387 (Scopus ID)
Available from: 2017-04-07 Created: 2017-04-07 Last updated: 2023-03-23Bibliographically approved
Schollin-Borg, M., Nordin, P., Zetterström, H. & Johansson, J. (2016). Blood Lactate Is a Useful Indicator for the Medical Emergency Team. Critical Care Research and Practice, Article ID 5765202.
Open this publication in new window or tab >>Blood Lactate Is a Useful Indicator for the Medical Emergency Team
2016 (English)In: Critical Care Research and Practice, ISSN 2090-1305, E-ISSN 2090-1313, article id 5765202Article in journal (Refereed) Published
Abstract [en]

Lactate has been thoroughly studied and found useful for stratification of patients with sepsis, in the Intensive Care Unit, and trauma care. However, little is known about lactate as a risk-stratification marker in the Medical Emergency Team-(MET-) call setting. We aimed to determine whether the arterial blood lactate level at the time of a MET-call is associated with increased 30-day mortality. This is an observational study on a prospectively gathered cohort at a regional secondary referral hospital. All MET-calls during the two-year study period were eligible. Beside blood lactate, age and vital signs were registered at the call. Among the 211 calls included, there were 64 deaths (30.3%). Median lactate concentration at the time of the MET-call was 1.82 mmol/L (IQR 1.16-2.7). We found differences between survivors and nonsurvivors for lactate and oxygen saturation, a trend for age, but no significant correlations between mortality and systolic blood pressure, respiratory rate, and heart rate. As compared to normal lactate (<2.44 mmol/L), OR for 30-day mortality was 3.54 (p < 0.0006) for lactate 2.44-5.0 mmol/L and 4.45 (p < 0.0016) for lactate >5.0 mmol/L. The present results support that immediate measurement of blood lactate in MET call patients is a useful tool in the judgment of illness severity.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2016
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-119091 (URN)10.1155/2016/5765202 (DOI)000372258000001 ()2-s2.0-84962303940 (Scopus ID)
Available from: 2016-04-15 Created: 2016-04-11 Last updated: 2024-04-09Bibliographically approved
Tydén, J., Herwald, H., Sjoberg, F. & Johansson, J. (2016). Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure. PLOS ONE, 11(3), Article ID e0152035.
Open this publication in new window or tab >>Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure
2016 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 3, article id e0152035Article in journal (Refereed) Published
Abstract [en]

Purpose: Heparin-binding protein (HBP) is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU) would be associated with decreased oxygenation or circulatory failure.

Methods: This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS) 3 was recorded on admission. Sequential organ failure assessment (SOFA) scores were recorded daily for three days.

Results: Median SAPS 3 was 58.8 (48-70) and 30-day mortality 64/278 (23%). There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p<0.001) as well as with circulatory failure (p<0.001), after 48-72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002). ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality.

Conclusions: A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population it's predictive value at the individual patient level is low.

Keywords
Biomarkers, Blood Proteins, Organ Dysfunction Scores
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-120365 (URN)10.1371/journal.pone.0152035 (DOI)000372701200089 ()27007333 (PubMedID)2-s2.0-84962052953 (Scopus ID)
Available from: 2016-05-16 Created: 2016-05-16 Last updated: 2023-03-24Bibliographically approved
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