• Acute kidney injury in intensive care units according to RIFLE classification: a population-based study.

      Sigurdsson, M I; Vesteinsdottir, I O; Sigvaldason, K; Helgadottir, S; Indridason, O S; Sigurdsson, G H; Department of Anaesthesia & Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland. (Wiley-Blackwell, 2012-11)
      Recent studies of the incidence of acute kidney injury (AKI) are largely based on estimated baseline serum creatinine values. The aim of this study was to more accurately determine the incidence of AKI using the RIFLE criteria for intensive care unit (ICU) patients of a whole population. All adult patients admitted to the ICUs of Landspitali - The National University Hospital of Iceland in 2007 (n = 1026) were studied with meticulous search for baseline creatinine. The underlying risk factors and contributing causes for AKI were defined, and survival and ratio of end-stage renal failure evaluated. A measured baseline creatinine value was found for all but two patients with AKI. The incidence of AKI according to RIFLE criteria was 21.7% [95% confidence interval (CI): 19.0-24.1%], with 7.1% (95 CI: 5.6-8.9%), 6.8% (95 CI: 5.3-8.5%) and 7.8% (95 CI: 6.2-9.6%) in the risk, injury and failure subgroups. Using estimated baseline creatinine overestimated the incidence of AKI by 3.5%. The sensitivity and specificity of the RIFLE criteria using estimated baseline creatinine were 76% and 95%. Renal replacement therapy was required for 17% of the AKI patients. One year survival of AKI patients was 51%, but only 2.5% of patients surviving 90 days required chronic renal replacement therapy. The incidence of AKI in the ICU was lower than previously published, perhaps due to overestimation of AKI using estimated baseline creatinine or bias from tertiary referrals. AKI patients have high mortality, but the survivors have a low incidence of end-stage renal failure.
    • Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years.

      Sigurdsson, M I; Sigvaldason, K; Gunnarsson, T S; Moller, A; Sigurdsson, G H; Landspitali Univ Hosp, Dept Anaesthesia & Intens Care Med, IS-101 Reykjavik, Iceland Univ Iceland, Fac Med, Reykjavik, Iceland (Wiley-Blackwell, 2013-01)
      The aim of this study was to assess population-based changes in incidence, treatment, and in short- and long-term survival of patients with acute respiratory distress syndrome (ARDS) over 23 years.
    • Airway closure in anesthetized infants and children: influence of inspiratory pressures and volumes.

      Thorsteinsson, A; Werner, O; Jonmarker, C; Larsson, A; Department of Anesthesia and Intensive Care, Landspitalinn University Hospital, Hringbraut, Iceland. adalbjn@landspitali.is (Blackwell Munksgaard, 2002-05-01)
      BACKGROUND: Cyclic opening and closing of lung units during tidal breathing may be an important cause of iatrogenic lung injury. We hypothesized that airway closure is uncommon in children with healthy lungs when inspiratory pressures are kept low, but paradoxically may occur when inspiratory pressures are increased. METHODS: Elastic equilibrium volume (EEV) and closing capacity (CC) were measured with a tracer gas (SF(6)) technique in 11 anesthetized, muscle-relaxed, endotracheally intubated and artificially ventilated healthy children, aged 0.6-13 years. Airway closing was studied in a randomized order at two inflation pressures, +20 or +30 cmH(2)O, and CC and CC/EEV were calculated from the plots obtained when the lungs were exsufflated to -20 cmH(2)O. (CC/EEV >1 indicates that airway closure might occur during tidal breathing). Furthermore, a measure of uneven ventilation, multiple breath alveolar mixing efficiency (MBAME), was obtained. RESULTS: Airway closure within the tidal volume (CC/EEV >1) was observed in four and eight children (not significant, NS) after 20 and 30 cmH(2)O inflation, respectively. However, CC(30)/EEV was >CC(20)/EEV in all children (P< or = 0.001). The MBAME was 75+/-7% (normal) and did not correlate with CC/EEV. CONCLUSION: Airway closure within tidal volumes may occur in artificially ventilated healthy children during ventilation with low inspiratory pressure. However, the risk of airway closure and thus opening within the tidal volume increases when the inspiratory pressures are increased.
    • Avoiding bladder catheterisation in total knee arthroplasty: patient selection criteria and low-dose spinal anaesthesia.

      Karason, S; Olafsson, T A; Landspitali University Hospital Reykjavik Iceland (Wiley-Blackwell, 2013-05)
      BACKGROUND: Bladder catheterisation may be inconvenient for patients, delay mobilisation and risk complications. We hypothesised that by excluding pre-operatively patients at high risk of post-operative urinary retention, the majority of patients could avoid perioperative catheterisation during low-dose spinal anaesthesia. METHODS: Patients undergoing total knee arthroplasty were assigned if fit for spinal anaesthesia and without severe symptoms of lower urinary tract obstruction, gross incontinence, mobilisation difficulties hindering micturition and > 200 ml residual urine volume. Bladder volume was monitored by ultrasound and temporary catheterisation advised if > 400 ml. RESULTS: Fifty-two patients (men 54%, age 65 ± 9 years, body mass index 31 ± 5, 30% with history of urinary tract problems) were included. Intrathecal hyperbaric bupivacaine given was 7.8 ± 1.08 mg and always 7.5 μg sufentanil providing sufficient anaesthesia in all cases. Crystalloid given during surgery was 8.5 ± 4.0 ml/kg. Voluntary micturition was reached by 46 patients (88%, confidence interval (CI) 79-97%), but six (12%, CI 3-21%) needed temporary catheterisation once (four men/two women). Larger bladder volumes were found in those catheterised than those with voluntary micturition on the pre-operative (131 ± 76 ml vs. 68 ± 57 ml, P = 0.03) and first post-operative bladder scan (445 ± 169 ml vs. 271 ± 129 ml, P = 0.004). All but two patients (96%) could be mobilised the same day. No patient suffered bladder dysfunction. CONCLUSION: Low-dose spinal anaesthesia combined with simple selection criteria allowed for early mobilisation (96%) and avoidance of bladder catheterisation in the vast majority (88%) of patients undergoing total knee arthroplasty, and the rest (12%) only needed a single temporary catheterisation.
    • Brain natriuretic peptide is a good predictor for outcome in cardiac surgery

      Eliasdottir, S B; Klemenzson, G; Torfason, B; Valsson, F; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. (Blackwell Munksgaard, 2008-02-01)
      BACKGROUND AND AIM: The heart secretes brain natriuretic peptide (BNP) in response to myocardial stretch. The aim of this study was to determine whether adverse effects after cardiac surgery were associated with higher serum BNP levels pre-operatively. METHODS: One hundred and thirty-five patients undergoing various cardiac procedures were included in the study, and N-terminal pro-BNP (NT-pro-BNP) was measured pre-operatively. Post-operative complications were defined as follows: (i) a post-operative length of stay in the intensive care unit (ICU) exceeding 48 h; (ii) mortality at 28 days; (iii) the need for inotropic agents and/or intra-aortic balloon pump (IABP); and (iv) renal failure. Serum NT-pro-BNP values were compared for patients with and without complications. The serum NT-pro-BNP level was also correlated with the euroSCORE and ejection fraction (EF). RESULTS: Pre-operative serum NT-pro-BNP levels were significantly higher in patients with an ICU length of stay of more than 2 days or death prior to post-operative day 28 (3118 ng/l vs. 705 ng/l; P < 0.001). Pre-operative serum NT-pro-BNP levels were also significantly higher in patients needing inotropic agents (2628 ng/l vs. 548 ng/l; P < 0.001) or IABP insertion (3705 ng/l vs. 935 ng/l; P = 0.001) or developing renal failure (2857 ng/l vs. 945 ng/l; P < 0.001) post-operatively. The correlation between the serum NT-pro-BNP level and euroSCORE was good (r = 0.658; P < 0.001). The receiver operating characteristic (ROC) curves were used to assess the ability of serum NT-pro-BNP, euroSCORE and EF to predict outcome after cardiac surgery. This revealed an area under the ROC curve for the length of stay in the ICU or mortality at 28 days of 0.829 for serum NT-pro-BNP, 0.814 for euroSCORE and 0.328 for EF assessed by transesophageal echocardiography, indicating that the pre-operative serum NT-pro-BNP level is a good prognostic indicator for outcome after cardiac surgery. CONCLUSION: Serum NT-pro-BNP is a good predictor for complications after cardiac surgery, and is as good as euroSCORE and better than EF.
    • Clinical practice guideline on gastrointestinal bleeding prophylaxis for critically ill patients: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

      Sverrisson, Kristinn Ö; Chew, Michelle S; Olkkola, Klaus T; Rehn, Marius; Yli-Hankala, Arvi; Møller, Morten Hylander; 1Department of Anaesthesia and Intensive Care Medicine, Landspítali University Hospital, Reykjavík, Iceland. 2Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 3Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 4Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway. 5The Norwegian Air Ambulance Foundation, Drøbak, Norway. 6Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. 7Department of Anaesthesia, Tampere University Hospital, Tampere, Finland. 8Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 9Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. (Wiley, 2020-12-28)
      The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical practice Committee endorses the BMJ Rapid Recommendation Gastrointestinal bleeding prophylaxis for critically ill patients-a clinical practice guideline. The guideline serves as a useful decision aid for clinicians caring for critically ill patients, and can be used together with clinical experience to decide whether a specific critically ill patient may benefit from gastrointestinal bleeding prophylaxis. Keywords: AGREE II; clinical practice guideline; critical care; critically ill; gastrointestinal bleeding prophylaxis.
    • Clinical practice guideline on prevention of rhabdomyolysis induced acute kidney injury: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

      Chew, Michelle S; Rehn, Marius; Olkkola, Klaus T; Örn Sverrisson, Kristinn; Yli-Hankala, Arvi; Møller, Morten Hylander (Wiley, 2019-08-22)
      The Scandinavian Society of Anaesthesiology and Intensive Care Medicine Clinical Practice Committee endorses the recent DASAIM/DSIT guideline for prevention of rhabdomyolysis-induced acute kidney injury. However, we emphasize the low quality of evidence with only weak recommendations for all interventions, highlighting that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimates.
    • Clinical practice guideline on spinal stabilisation of adult trauma patients: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

      Yli-Hankala, Arvi; Chew, Michelle S; Olkkola, Klaus T; Rehn, Marius; Sverrisson, Kristinn Ö; Møller, Morten H; 1Department of Anaesthesia, Tampere University Hospital, Tampere, Finland. 2Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. 3Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 4Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 5Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway. 6The Norwegian Air Ambulance Foundation, Oslo, Norway. 7Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. 8Department of Anaesthesia and Intensive Care Medicine, Landspítali University Hospital, Reykjavík, Iceland. 9Department of Intensive Care, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark. 10Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark. (Wiley, 2021-06-24)
      The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline New clinical guidelines on the spinal stabilisation of adult trauma patients-consensus and evidence based. The guideline can serve as a useful decision aid for clinicians caring for patients with traumatic spinal cord injury. However, it is important to acknowledge that the overall certainty of evidence supporting the guideline recommendations was low, implying that further research is likely to have an important impact on the confidence in the estimate of effect. Keywords: SSAI; clinical practice guideline; endorsement; spinal stabilisation; trauma.
    • Clinical practice guideline on the management of septic shock and sepsis-associated organ dysfunction in children: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

      Rehn, Marius; Chew, Michelle S; Olkkola, Klaus T; Sigurðsson, Martin Ingi; Yli-Hankala, Arvi; Møller, Morten Hylander; 1Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway. 2The Norwegian Air Ambulance Foundation, Drøbak, Norway. 3Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. 4Department of Anaesthesia and Intensive Care, Medicine and Health, Linköping University, Linkoping, Sweden. 5Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 6Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavík, Iceland. 7Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 8Department of Anaesthesia, Tampere University Hospital, Tampere, Finland. 9Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. 10Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 11Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark. (Wiley, 2021-08-04)
      The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction. Keywords: AGREE II; children; clinical practice guideline; paediatrics; sepsis; septic shock.
    • Current use of nitrous oxide in public hospitals in Scandinavian countries.

      Husum, B; Stenqvist, O; Alahuhta, S; Sigurdsson, G H; Dale, O; Hillerod Hosp, Dept Anaesthesiol, DK-3400 Hillerod, Denmark, Sahlgrens Univ Hosp, Dept Anaesthesiol & Intens Care, Gothenburg, Sweden, Oulu Univ Hosp, Dept Anaesthesiol, Oulu, Finland, Univ Iceland, Landspitali Univ Hosp, Dept Anaesthesia & Intens Care Med, Reykjavik, Iceland, Norwegian Univ Sci & Technol, Dept Cirkulat & Med Imaging, N-7034 Trondheim, Norway (Wiley-Blackwell, 2013-10)
      The use of nitrous oxide in modern anaesthesia has been questioned. We surveyed changes in use of nitrous oxide in Scandinavia and its justifications during the last two decades.
    • A descriptive study of the surge response and outcomes of ICU patients with COVID-19 during first wave in Nordic countries.

      Chew, Michelle S; Kattainen, Salla; Haase, Nicolai; Buanes, Eirik A; Kristinsdottir, Linda B; Hofsø, Kristin; Laake, Jon Henrik; Kvåle, Reidar; Hästbacka, Johanna; Reinikainen, Matti; et al. (Wiley, 2021-10-03)
      Background: We sought to provide a description of surge response strategies and characteristics, clinical management and outcomes of patients with severe COVID-19 in the intensive care unit (ICU) during the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Methods: Representatives from the national ICU registries for each of the five countries provided clinical data and a description of the strategies to allocate ICU resources and increase the ICU capacity during the pandemic. All adult patients admitted to the ICU for COVID-19 disease during the first wave of COVID-19 were included. The clinical characteristics, ICU management and outcomes of individual countries were described with descriptive statistics. Results: Most countries more than doubled their ICU capacity during the pandemic. For patients positive for SARS-CoV-2, the ratio of requiring ICU admission for COVID-19 varied substantially (1.6%-6.7%). Apart from age (proportion of patients aged 65 years or over between 29% and 62%), baseline characteristics, chronic comorbidity burden and acute presentations of COVID-19 disease were similar among the five countries. While utilization of invasive mechanical ventilation was high (59%-85%) in all countries, the proportion of patients receiving renal replacement therapy (7%-26%) and various experimental therapies for COVID-19 disease varied substantially (e.g. use of hydroxychloroquine 0%-85%). Crude ICU mortality ranged from 11% to 33%. Conclusion: There was substantial variability in the critical care response in Nordic ICUs to the first wave of COVID-19 pandemic, including usage of experimental medications. While ICU mortality was low in all countries, the observed variability warrants further attention. Keywords: COVID-19; Nordic; SARS-CoV2; mortality.
    • Electrical impedence tomography and heterogeneity of pulmonary perfusion and ventilation in porcine acute lung injury.

      Fagerberg, A; Söndergaard, S; Karason, S; Aneman, A; Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Blå Stråket 5, Gothenburg, Sweden. (Wiley-Blackwell, 2009-11-01)
      BACKGROUND: The heterogeneity of pulmonary ventilation (V), perfusion (Q) and V/Q matching impairs gas exchange in an acute lung injury (ALI). This study investigated the feasibility of electrical impedance tomography (EIT) to assess the V/Q distribution and matching during an endotoxinaemic ALI in pigs. METHODS: Mechanically ventilated, anaesthetised pigs (n=11, weight 30-36 kg) were studied during an infusion of endotoxin for 150 min. Impedance changes related to ventilation (Z(V)) and perfusion (Z(Q)) were monitored globally and bilaterally in four regions of interest (ROIs) of the EIT image. The distribution and ratio of Z(V) and Z(Q) were assessed. The alveolar-arterial oxygen difference, venous admixture, fractional alveolar dead space and functional residual capacity (FRC) were recorded, together with global and regional lung compliances and haemodynamic parameters. Values are mean+/-standard deviation (SD) and regression coefficients. RESULTS: Endotoxinaemia increased the heterogeneity of Z(Q) but not Z(V). Lung compliance progressively decreased with a ventral redistribution of Z(V). A concomitant dorsal redistribution of Z(Q) resulted in mismatch of global (from Z(V)/Z(Q) 1.1+/-0.1 to 0.83+/-0.3) and notably dorsal (from Z(V)/Z(Q) 0.86+/-0.4 to 0.51+/-0.3) V and Q. Changes in global Z(V)/Z(Q) correlated with changes in the alveolar-arterial oxygen difference (r(2)=0.65, P<0.05), venous admixture (r(2)=0.66, P<0.05) and fractional alveolar dead space (r(2)=0.61, P<0.05). Decreased end-expiratory Z(V) correlated with decreased FRC (r(2)=0.74, P<0.05). CONCLUSIONS: EIT can be used to assess the heterogeneity of regional pulmonary ventilation and perfusion and V/Q matching during endotoxinaemic ALI, identifying pivotal pathophysiological changes.
    • Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

      Rehn, Marius; Chew, Michelle S; Olkkola, Klaus T; Örn Sverrison, Kristinn; Yli-Hankala, Arvi; Møller, Morten Hylander; 1 Pre-hospital division, Air ambulance department, Oslo university hospital, Oslo, Norway. 2 The Norwegian Air Ambulance Foundation, Drøbak, Norway. 3 Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. 4 Department of Anaesthesia and Intensive Care, Medicine and Health, Linköping University, Linköping, Sweden. 5 Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 6 Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavík, Iceland. 7 Department of Anaesthesia, Tampere University Hospital, Tampere, Finland. 8 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. 9 Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. (Wiley, 2019-02-01)
      Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement.
    • Femoral nerve blocks for the treatment of acute pre-hospital pain: A systematic review with meta-analysis.

      Raatiniemi, Lasse; Magnusson, Vidar; Hyldmo, Per K; Friesgaard, Kristian D; Kongstad, Poul; Kurola, Jouni; Larsen, Robert; Rehn, Marius; Rognås, Leif; Sandberg, Mårten; et al. (Wiley, 2020-04-09)
      Background: Pain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre- and post-operative pain management for patients with femoral fractures but its role in the pre-hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre-hospital setting. Methods: A systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments. Results: Four studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone and was only included here for information regarding adverse effects. One case series included 90 patients. Few adverse events were reported in the included studies. The certainty of evidence was very low. We found no studies comparing FNB to inhaled analgesics, opioids or ketamine. Conclusions: Evidence regarding the effectiveness and adverse effects of pre-hospital FNB is limited. Studies comparing pre-hospital FNB to inhaled analgesics, opioids or ketamine are lacking.
    • Fluid management in the critically ill: science or invention?

      Wernerman, J; Sigurdsson, G H; [ 1 ] Karolinska Univ, Huddinge Hosp, Dept Anesthesia & Intens Care Med, Stockholm, Sweden [ 2 ] Karolinska Inst, Stockholm, Sweden [ 3 ] Landspitali Univ Hosp, Dept Anaesthesia & Intens Care Med, Reykjavik, Iceland   Organization-Enhanced Name(s)      Landspitali National University Hospital [ 4 ] Univ Iceland, Fac Med, Reykjavik, Iceland (Wiley-Blackwell, 2016-02)
    • Haemostatic effect of aprotinin during craniosynostotic surgery in children.

      Gunnarsson, I; Hlynsson, B Ö; Rosmundsson, Th; Thorsteinsson, A; Department of Anaesthesiology and Intensive Care, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. ivargunn@landspitali.is (Wiley-Blackwell, 2011-09)
      BACKGROUND: Aprotinin has been used in our hospital since the year 2003 to reduce bleeding during craniosynostotic surgery in children. The aim of this retrospective study was to investigate its effect, primarily on bleeding and secondarily on the need for transfusion. METHODS: Thirteen children were treated with aprotinin from 2003 to 2008, while 39 were not treated in the period 1993-2002. Information on blood loss and need for transfusion during the operations in all 52 children was collected from their medical records. RESULTS: There was a significant difference in both blood loss and need for transfusion. Estimated blood volume was used to correct for difference in the children's age and size. In the aprotinin group, blood loss was 3.9% of circulating blood volume vs. 22.0%, and the need for transfusion was 0.0% vs. 21.1%. CONCLUSION: Blood loss and need for blood transfusion were significantly reduced in the aprotinin group. No allergic or other possible aprotinin-specific complications were registered in the aprotinin group.
    • Indexing haemodynamic variables in young children.

      Sigurdsson, Theodor S; Lindberg, Lars; 1Department of Paediatric Anaesthesiology and Intensive Care Medicine, Lund Children´s Hospital, Skåne University Hospital, Lund, Sweden. 2Department of Anaesthesiology and Intensive Care Medicine, Landspitalinn University Hospital, Reykjavik, Iceland. (https://onlinelibrary.wiley.com/doi/10.1111/aas.13720, 2020-10-05)
      Background: Haemodynamic studies in children are rare and most studies have included few subjects in the youngest age group. Haemodynamic variables need to be indexed to establish a reference of normality that is valid in all populations. The traditional way to index haemodynamic variables with body surface area (BSA) is complicated in young children due to its non-linear relationship with body weight (BW). We examined several haemodynamic variables in children by indexing them with BSA and BW. Methods: A single-centre, observational cohort study comparing non-indexed and indexed haemodynamic variables in children undergoing heart surgery (divided into three weight groups: 1-5 kg, >5-10 kg and >10-15 kg). Results: A total of 68 children were included in this study, mean age 11.1 months ± 11.1 month (range 0 to 43 months). All haemodynamic variables, cardiac output (CO), stroke volume (SV), total end-diastolic volume (TEDV), central blood volume (CBV) and active circulation volume (ACV), increased with weight without indexing (P < .05). Indexing variables with BW produced a more linear relationship for all haemodynamic variables between weight groups than BSA. The mean BSA-indexed haemodynamic values were CIBSA 3.5 ± 1.1 L/min/m2 and SVIBSA 27.3 ± 8.9 ml/min/m2 . The mean BW-indexed haemodynamic values were CIBW 180 ± 50 ml/min/kg and SVIBW 1.34 ± 0.38 ml/kg. Blood volume variables indexed with BW were TEDVBW 12.0 ± 2.8 ml/kg, CBVBW 21.3 ± 6.6 ml/kg and ACVBW 70.3 ± 15.2 ml/kg. Conclusions: Indexing haemodynamic variables with BW produces a more appropriate body size-independent scale in young children than BSA. Summary statement: In this study, we studied indexing of haemodynamic variables and estimation of blood volumes in young children undergoing corrective heart surgery using an indicator dilution technology. Keywords: blood volume; body surface area; body weight; cardiac output; children; indexing.
    • Induced hypothermia in comatose survivors of asphyxia: a case series of 14 consecutive cases

      Baldursdottir, S; Sigvaldason, K; Karason, S; Valsson, F; Sigurdsson, G H; Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland. (2010-08)
      BACKGROUND: Induced hypothermia is widely used for comatose survivors of cardiac arrest. Other causes of hypoxic brain injury carry a poor prognosis when treated using traditional methods. At our hospital, hypothermia has also been used for the management of all comatose survivors of asphyxiation. The aim of the present study was to report the results of the management of these patients. METHODS: Hospital charts of all patients admitted unconscious after asphyxiation during a 7-year period were reviewed. This included patients after hanging, drowning, carbon monoxide intoxication and other gas intoxications. In all patients, hypothermia with a target temperature of 32-34 degrees C was induced with external or intravascular cooling for 24 h. The primary outcome was neurologic function at discharge. RESULTS: Fourteen male patients were treated with hypothermia, eight after hanging, three after drowning, two after carbon monoxide intoxication and one after methane intoxication. All were deeply comatose (Glasgow Coma Score 3-5) on arrival to hospital. Nine had been resuscitated from cardiac arrest. There were nine survivors (65%), all with good neurological recovery (Cerebral Performance Category 1-2). Four out of five non-survivors showed cerebral edema already on arrival computed tomographic (CT) scan while none of the nine survivors did. CONCLUSIONS: The results of this study suggest that an early abnormal CT scan of the brain in patients resuscitated after asphyxiation carries an adverse prognosis. The favorable outcome of the patients in the present study suggests that a randomized clinical trial on the use of induced hypothermia in patients exposed to severe asphyxia might be warranted.
    • Intravenous fluid management in critically ill patients: for everybody or for a dedicated team?

      Wernerman, J; Sigurdsson, G H; [ 1 ] Karolinska Univ Hosp Huddinge, Dept Anaesthesia & Intens Care Med, Stockholm, Sweden [ 2 ] Karolinska Inst, Stockholm, Sweden [ 3 ] Landspitali Univ Hosp, Dept Anaesthesia & Intens Care Med, Reykjavik, Iceland ??Organization-Enhanced Name(s) ???? Landspitali National University Hospital [ 4 ] Univ Iceland, Fac Med, Reykjavik, Iceland (Wiley-Blackwell, 2016-07)
    • Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey

      Darvish, B; Gupta, A; Alahuhta, S; Dahl, V; Helbo-Hansen, S; Thorsteinsson, A; Irestedt, L; Dahlgren, G; Department of Anesthesia and Intensive Care, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden. bijan.darvish@orebroll.se (Wiley-Blackwell, 2011-01)
      BACKGROUND: a major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post-dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries. METHODS: a postal questionnaire was sent to the anaesthesiologist responsible for Obstetric anaesthesia service in all maternity units (n=153) with questions relating to the year 2008. RESULTS: the overall response rate was 93%. About 32% (22-47%) of parturients received epidural analgesia for labour. There were databases for registering obstetric epidural complications in 13% of Danish, 24% of Norwegian and Swedish, 43% of Finnish and 100% of hospitals in Iceland. The estimated incidence of ADP was 1% (n approximately 900). Epidural blood patch (EBP) was performed in 86% (n≈780) of the parturients. The most common time interval from diagnosis to performing EBP was 24-48 h. The success rate for EBP was >75% in 67% (62-79%) of hospitals. The use of diagnostic CT/MRI before the first or the second EBP was exceptional. No major complication was reported. Teaching of epidurals was commonest (86%) in the non-obstetric population and 53% hospitals desired a formal training programme in obstetric analgesia. CONCLUSION: we found the incidence of ADP to be approximately 1%. EBP was the commonest method used for its management, and the success rate was high in most hospitals. Formal training in epidural analgesia was absent in most countries and trainees first performed it in the non-obstetric population.