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Acute respiratory failure in intensive care units. FINNALI: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature150309
Source
Intensive Care Med. 2009 Aug;35(8):1352-61
Publication Type
Article
Date
Aug-2009
Author
Rita Linko
Marjatta Okkonen
Ville Pettilä
Juha Perttilä
Ilkka Parviainen
Esko Ruokonen
Jyrki Tenhunen
Tero Ala-Kokko
Tero Varpula
Author Affiliation
Intensive Care Units, Department of Anaesthesia and Intensive Care Medicine, Division of Surgery, Helsinki University Hospital, Helsinki, Finland. rita.linko@hus.fi
Source
Intensive Care Med. 2009 Aug;35(8):1352-61
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Female
Finland - epidemiology
Humans
Intensive Care Units
Male
Middle Aged
Prospective Studies
Respiration, Artificial - utilization
Respiratory Distress Syndrome, Adult - etiology - mortality - physiopathology - therapy
Risk factors
Tidal Volume - physiology
Treatment Outcome
Abstract
To evaluate the incidence, treatment and mortality of acute respiratory failure (ARF) in Finnish intensive care units (ICUs).
Prospective multicentre cohort study.
All adult patients in 25 ICUs were screened for use of invasive or non-invasive ventilatory support during an 8-week period. Patients needing ventilatory support for more than 6 h were included and defined as ARF patients. Risk factors for ARF and details of prior chronic health status were assessed. Ventilatory and concomitant treatments were evaluated and recorded daily throughout the ICU stay. ICU and 90-day mortalities were assessed.
A total of 958 (39%) from the 2,473 admitted patients were treated with ventilatory support for more than 6 h. Incidence of ARF, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) was 149.5, 10.6 and 5.0/100,000 per year, respectively. Ventilatory support was started with non-invasive interfaces in 183 of 958 (19%) patients. Ventilatory modes allowing triggering of spontaneous breaths were preferred (81%). Median tidal volume/predicted body weight was 8.7 (7.6-9.9) ml/kg and plateau pressure 19 (16-23) cmH2O. The 90-day mortality of ARF was 31%.
While the incidence of ARF requiring ventilatory support is higher, the incidence of ALI and ARDS seems to be lower in Finland than previously reported in other countries. Tidal volumes are higher than recommended in the concept of lung protective strategy. However, restriction of peak airway pressure was used in the majority of ARF patients.
Notes
Comment In: Intensive Care Med. 2009 Aug;35(8):1328-3019526219
PubMed ID
19526218 View in PubMed
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Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage.

https://arctichealth.org/en/permalink/ahliterature71799
Source
Stroke. 2001 Dec 1;32(12):2845-949
Publication Type
Article
Date
Dec-1-2001
Author
M. Johansson
K G Cesarini
C F Contant
L. Persson
P. Enblad
Author Affiliation
Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
Source
Stroke. 2001 Dec 1;32(12):2845-949
Date
Dec-1-2001
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Attitude of Health Personnel
Cerebral Angiography
Disease Management
Female
Follow-Up Studies
Glasgow Outcome Scale
Hospitals, University
Humans
Intensive Care
Logistic Models
Male
Neuropsychological Tests - statistics & numerical data
Outcome Assessment (Health Care) - statistics & numerical data - trends
Respiration, Artificial - utilization
Severity of Illness Index
Subarachnoid Hemorrhage - diagnosis - mortality - therapy
Sweden - epidemiology
Tomography, X-Ray Computed
Vascular Surgical Procedures - utilization
Ventriculostomy - utilization
Abstract
BACKGROUND AND PURPOSE: The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage. METHODS: Two hundred eighty-one patients >/=65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998. RESULTS: The volume of elderly patients (>/=65 years of age) increased with time, especially patients >/=70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%; B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients. CONCLUSIONS: Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.
PubMed ID
11739985 View in PubMed
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The Effect of ß-blockade on Survival After Isolated Severe Traumatic Brain Injury.

https://arctichealth.org/en/permalink/ahliterature270247
Source
World J Surg. 2015 Aug;39(8):2076-83
Publication Type
Article
Date
Aug-2015
Author
Shahin Mohseni
Peep Talving
Eric P Thelin
Göran Wallin
Olle Ljungqvist
Louis Riddez
Source
World J Surg. 2015 Aug;39(8):2076-83
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Abbreviated Injury Scale
Adrenergic beta-Antagonists - therapeutic use
Adult
Age Factors
Aged
Brain Injuries - mortality - therapy
Cohort Studies
Female
Hematoma, Epidural, Cranial - mortality - therapy
Hematoma, Subdural - mortality - therapy
Hospital Mortality
Humans
Intensive Care Units - utilization
Length of Stay - statistics & numerical data
Logistic Models
Male
Middle Aged
Multivariate Analysis
Protective factors
Registries
Respiration, Artificial - utilization
Retrospective Studies
Risk
Subarachnoid Hemorrhage - mortality - therapy
Sweden
Trauma Centers
Young Adult
Abstract
Several North American studies have observed survival benefit in patients exposed to ß-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of ß-blockade on mortality in a Swedish cohort of isolated severe TBI patients.
The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS)=3 excluding extra-cranial injuries AIS=3. Multivariable logistic regression analysis was used to determine the effect of ß-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission ß-blocker versus not and the effect of specific type of ß-blocker on the overall outcome.
Overall, 874 patients met the study criteria. Of these, 33% (n=287) were exposed to ß-blockers during their hospital admission. The exposed patients were older (62±16 years vs. 49±21 years, p
PubMed ID
25809062 View in PubMed
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Home mechanical ventilation in Sweden--inequalities within a homogenous health care system.

https://arctichealth.org/en/permalink/ahliterature30520
Source
Respir Med. 2004 Jan;98(1):38-42
Publication Type
Article
Date
Jan-2004
Author
Michael Laub
Sören Berg
Bengt Midgren
Author Affiliation
Department of Respiratory Medicine, University Hospital, Lund 221 85, Sweden.
Source
Respir Med. 2004 Jan;98(1):38-42
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Child
Child, Preschool
Female
Health Care Rationing - statistics & numerical data
Home Care Services - utilization
Humans
Infant
Infant, Newborn
Male
Middle Aged
Obesity Hypoventilation Syndrome - epidemiology - therapy
Prospective Studies
Research Support, Non-U.S. Gov't
Respiration, Artificial - utilization
Respiratory Insufficiency - epidemiology - etiology - therapy
Sweden - epidemiology
Abstract
We examined local differences in prescription pattern of home mechanical ventilation (HMV) within the homogenous health care system in Sweden. We used 6 years prospective data from the national HMV Register covering the entire Swedish HMV patient population (more than 1000 patients). The treatment prevalence of HMV in Sweden, January 1, 1996 was 6.2/100,000 and January 1, 2002 10.5/100,000 with a steady increase each year in all counties. The differences between leading and non-leading counties showed a tendency to diminish due to an increasing prescription rate in the non-leading counties. During the 6 years, the proportion of Pickwickian patients increased significantly in the country as a whole, but remained considerably and significantly higher in the leading counties, in spite of similar and temporally stable prescription criteria. Even if the evident dissimilarities in treatment prevalence may be levelling out, it will most probably do so at a level as high as or higher than today's top level of more than 20/100,000 since we found that HMV therapy was well founded also in the counties with the highest prescription rates and that the prescription rate of the non-leading counties was approaching the level of the leading counties.
PubMed ID
14959812 View in PubMed
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Long-term survival after burns in a Swedish population.

https://arctichealth.org/en/permalink/ahliterature280966
Source
Burns. 2017 Feb;43(1):157-161
Publication Type
Article
Date
Feb-2017
Author
Laura Pompermaier
Ingrid Steinvall
Mats Fredrikson
Johan Thorfinn
Folke Sjöberg
Source
Burns. 2017 Feb;43(1):157-161
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Body surface area
Burn Units
Burns - mortality - therapy
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Middle Aged
Proportional Hazards Models
Respiration, Artificial - utilization
Retrospective Studies
Survival Rate
Survivors
Sweden - epidemiology
Trauma Severity Indices
Young Adult
Abstract
As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns.
We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors.
Age and a full-thickness burn were significantly associated with mortality after discharge (p
PubMed ID
27613474 View in PubMed
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Long-term ventilation for patients with Duchenne muscular dystrophy : physicians' beliefs and practices.

https://arctichealth.org/en/permalink/ahliterature195410
Source
Chest. 2001 Mar;119(3):940-6
Publication Type
Article
Date
Mar-2001
Author
B. Gibson
Author Affiliation
Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. barbara.gibson@utoronto.ca
Source
Chest. 2001 Mar;119(3):940-6
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Ethics, Medical
Female
Humans
Male
Middle Aged
Muscular Dystrophy, Duchenne - complications - therapy
Physician's Practice Patterns
Quality of Life
Questionnaires
Respiration, Artificial - utilization
Time Factors
Truth Disclosure
Abstract
Although long-term ventilation (LTV) has been shown to extend the lives of individuals with Duchenne muscular dystrophy (DMD), initiating LTV is still considered controversial. The purpose of the study was to describe the LTV-related attitudes and practices of Canadian physicians who follow up patients with DMD.
The study consisted of a mail questionnaire supplemented by face-to-face interviews.
Forty-five physicians who follow up patients with DMD through Canadian neuromuscular clinics.
A mail questionnaire of 66 closed-ended questions related to practice and attitudes was completed by all respondents. Qualitative semistructured interviews were conducted with six volunteer physicians, and were audiotaped and transcribed.
The results indicated that 25.0% of physicians do not discuss LTV with all of their DMD patients. The most frequently cited reason for advising against LTV was poor patient quality of life (52.6%). Three themes emerged from the qualitative data: mentioning and discussing LTV are discrete events with different purposes, nighttime and full-time LTV decisions are approached differently, and physicians modify their discussions to influence outcome.
The study demonstrated considerable agreement among the physicians regarding disclosure practices. Concerns are raised by the number of physicians who do not disclose to all patients and families and the role of quality-of-life judgments in decision making. It is suggested that because of their subjective nature, quality-of-life judgments should not be made without the participation of the patient and family, and that an initial disclosure is the minimum requirement of informed consent/decision making.
Notes
Comment In: Chest. 2001 Mar;119(3):683-411243942
PubMed ID
11243978 View in PubMed
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A looming crisis in demand for intensive care unit resources?

https://arctichealth.org/en/permalink/ahliterature175843
Source
Crit Care Med. 2005 Mar;33(3):683-4
Publication Type
Article
Date
Mar-2005

Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy.

https://arctichealth.org/en/permalink/ahliterature283660
Source
Pediatrics. 2016 Nov;138(5)
Publication Type
Article
Date
Nov-2016
Author
Ulrika Nörby
Lisa Forsberg
Katarina Wide
Gunnar Sjörs
Birger Winbladh
Karin Källén
Source
Pediatrics. 2016 Nov;138(5)
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - adverse effects
Central Nervous System Diseases - epidemiology
Continuous Positive Airway Pressure - utilization
Female
Humans
Hypertension, Pulmonary - epidemiology
Hypoglycemia - epidemiology
Infant, Newborn
Intensive Care Units, Neonatal
Male
Patient Admission - statistics & numerical data
Pregnancy
Prenatal Exposure Delayed Effects
Registries
Respiration, Artificial - utilization
Respiratory Tract Diseases - epidemiology
Serotonin Uptake Inhibitors - adverse effects
Sweden - epidemiology
Young Adult
Abstract
To estimate the rate of admissions to NICUs, as well as infants' morbidity and neonatal interventions, after exposure to antidepressant drugs in utero.
Data on pregnancies, deliveries, prescription drug use, and health status of the newborn infants were obtained from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register. We included 741?040 singletons, born between July 1, 2006, and December 31, 2012. Of the infants, 17?736 (2.4%) had mothers who used selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Infants exposed to an SSRI were compared with nonexposed infants, and infants exposed during late pregnancy were compared with those exposed during early pregnancy only. The results were analyzed with logistic regression analysis.
After maternal use of an SSRI, 13.7% of the infants were admitted to the NICU compared with 8.2% in the population (adjusted odds ratio: 1.5 [95% confidence interval: 1.4-1.5]). The admission rate to the NICU after treatment during late pregnancy was 16.5% compared with 10.8% after treatment during early pregnancy only (adjusted odds ratio: 1.6 [95% confidence interval: 1.5-1.8]). Respiratory and central nervous system disorders and hypoglycemia were more common after maternal use of an SSRI. Infants exposed to SSRIs in late pregnancy compared with early pregnancy had a higher risk of persistent pulmonary hypertension (number needed to harm: 285).
Maternal use of antidepressants during pregnancy was associated with increased neonatal morbidity and a higher rate of admissions to the NICU. The absolute risk for severe disease was low, however.
PubMed ID
27940758 View in PubMed
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Outcomes following neonatal patent ductus arteriosus ligation done by pediatric surgeons: a retrospective cohort analysis.

https://arctichealth.org/en/permalink/ahliterature113671
Source
J Pediatr Surg. 2013 May;48(5):915-8
Publication Type
Article
Date
May-2013
Author
Katherine Hutchings
Andrea Vasquez
David Price
Brian H Cameron
Saeed Awan
Grant G Miller
Author Affiliation
Department of Surgery, Janeway Children's Hospital, St. John's Newfoundland, NL, Canada, A1B 3V6.
Source
J Pediatr Surg. 2013 May;48(5):915-8
Date
May-2013
Language
English
Publication Type
Article
Keywords
Blood Transfusion - utilization
Canada - epidemiology
Comorbidity
Ductus Arteriosus, Patent - drug therapy - mortality - surgery
Female
Follow-Up Studies
General Surgery - education
Gestational Age
Hospital Mortality
Hospitals, Pediatric - organization & administration - statistics & numerical data
Hospitals, Teaching - organization & administration - statistics & numerical data
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - mortality - surgery
Intensive Care Units, Neonatal - statistics & numerical data
Intraoperative Complications - epidemiology
Ligation - education
Male
Patient Transfer - statistics & numerical data
Pediatrics - education
Postoperative Complications - epidemiology
Respiration, Artificial - utilization
Retrospective Studies
Tertiary Care Centers - organization & administration - statistics & numerical data
Treatment Outcome
Abstract
Patent Ductus Arteriosus (PDA) ligation in premature infants is an urgent procedure performed by some but not all pediatric surgeons. Proficiency in PDA ligation is not a requirement of Canadian pediatric surgery training. Our purpose was to determine the outcomes of neonatal PDA ligation done by pediatric surgeons.
We performed a retrospective review of premature infants who underwent PDA ligation by pediatric surgeons in 3 Canadian centers from 2005 to 2009. Outcomes were compared to published controls.
The review identified 98 patients with a mean corrected GA and weight at repair of 29 weeks and 1122 g, respectively. There were no intraoperative deaths. The 30-day and inhospital mortality rates were 1% and 5%. Mortality and morbidity were comparable to the published outcomes.
This study documents that a significant number of preterm infant PDA ligations are safely done by pediatric surgeons. To meet the Canadian needs for this service by pediatric surgeons, proficiency in PDA ligation should be considered important in pediatric surgery training programs.
PubMed ID
23701759 View in PubMed
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Perinatal management of congenital diaphragmatic hernia: when and how should babies be delivered? Results from the Canadian Pediatric Surgery Network.

https://arctichealth.org/en/permalink/ahliterature138873
Source
J Pediatr Surg. 2010 Dec;45(12):2334-9
Publication Type
Article
Date
Dec-2010
Author
Arash Safavi
Yi Lin
Erik D Skarsgard
Author Affiliation
Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Source
J Pediatr Surg. 2010 Dec;45(12):2334-9
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Birth weight
Canada
Cesarean Section - utilization
Databases, Factual
Delivery, Obstetric - methods
Electronic Health Records
Enteral Nutrition - utilization
Extracorporeal Membrane Oxygenation - utilization
Female
Gestational Age
Hernia, Diaphragmatic - congenital - diagnosis - mortality
Humans
Infant, Newborn
Information Services
Length of Stay
Perinatal care
Pregnancy
Prenatal Diagnosis
Respiration, Artificial - utilization
Surgical Procedures, Elective - utilization
Treatment Outcome
Abstract
A prenatal diagnosis of congenital diaphragmatic hernia (CDH) enables therapeutic decision making during the intrapartum period. This study seeks to identify the gestational age and delivery mode associated with optimal outcomes.
A national data set was used to study CDH babies born between 2005 and 2009. The primary outcome was survival to discharge. Primary and secondary outcomes were analyzed by categorical gestational age (preterm, 39 weeks) by intended and actual route of delivery and by birth plan conformity, regardless of route.
Of 214 live born babies (gestational age, 37.6 ± 4.0 weeks; birth weight, 3064 ± 696 g), 143 (66.8%) had a prenatal diagnosis and 174 (81.3%) survived to discharge. Among 143 prenatally diagnosed pregnancies, 122 (85.3%) underwent abdominal delivery (AD) and 21 (14.6%) underwent cesarean delivery (CS). Conformity between intended and actual delivery occurred in 119 (83.2%). Neither categorical gestational age nor delivery route influenced outcome. Although babies delivered by planned CS had a lower mortality than those delivered by planned AD (2/21 and 36/122, respectively; P = .04), this difference was not significant by multivariate analysis. Conformity to any birth plan was associated with a trend toward improved survival.
Our data do not support advocacy of any specific delivery plan or route nor optimal gestational age for prenatally diagnosed CDH.
PubMed ID
21129540 View in PubMed
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18 records – page 1 of 2.