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  • 1.
    Björling, Gunilla
    et al.
    Department of Nursing, Karolinska Institutet, Danderyd University Hospital.
    Johansson, Unn-Britt
    Sophiahemmet University College.
    Andersson, G
    Respiratory Unit, Division of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd University Hospital.
    Schedin, Ulla
    Respiratory Unit, Division of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd University Hospital.
    Markström, A
    Respiratory Unit, Division of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd University Hospital.
    Frostell, C
    Department of Anesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm.
    A retrospective survey of outpatients with long-term tracheostomy2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 4, p. 399-406Article in journal (Refereed)
    Abstract [en]

    Background:  The Respiratory Unit (RU) at Danderyd University Hospital opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The primary aim of this retrospective study in tracheostomized patients was to compare the need for hospital care in the 2-year period before and after the tracheostomy.

    Methods:  Data were collected from patient medical records at the RU, from the National Board of Health and Welfare, Sweden and from the Official Statistics of Sweden. The subjects were RU patients in 1982 (Group 1, n = 27) and in 1997 (Group 2, n = 106) with long-term tracheostomy surviving at least 4 years after the tracheostomy.

    Results:  Both groups had few and unchanged needs for hospital care after tracheostomy. They spent ≥ 96% of their time out of hospital. In 1997, (group 2) the number of patients, diagnoses and need for home mechanical ventilation had increased. Life expectancy was assessed for patients in Group 1. Data showed that they lived as long as an age-matched and gender-adjusted control cohort.

    Conclusions:  Long-term tracheostomy may not increase the need for hospital care and does not reduce life expectancy. These clinical observations were made in a setting where patients had regular access to a dedicated outpatient unit.

  • 2.
    Holmér Pettersson, Pia
    et al.
    Department of Surgical Sciences, Karolinska Institute, Division of Cardiothoracic Anaesthesia and Intensive Care, Karolinska Hospital, Stockholm.
    Anjou Lindskog, Elisabet
    Öwall, Anders
    Patient-controlled versus nurse-controlled pain treatment after coronary artery bypass surgery2000In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, ISSN 1399-6576, Vol. 44, no 1, p. 43-47Article in journal (Refereed)
    Abstract [en]

    Background: Pain after coronary artery bypass surgery persists for several days. A continuous intravenous infusion of an opioid adequately accomplishes good pain control in the intensive care unit, but it is often not suitable on the ordinary ward. Patient-controlled analgesia (PCA) with intermittent injections delivered by one of the new devices now available could be an alternative to conventional nurse-controlled analgesia (NCA) based on intermittent injections. The aim was to compare these two techniques with respect to efficacy and the amount of opioid used.

    Methods: Forty-eight patients randomly received PCA or NCA with ketobemidone following extubation after coronary artery bypass grafting. Drug consumption, pain assessment with the visual analogue score (VAS) and possible side effects were evaluated from extubation to the end of the second postoperative day.

    Results: On the day of surgery the VAS scores did not differ between the groups. From the afternoon of the first postoperative day the VAS scores were higher in the NCA group with mean values at 3–4 out of 10 as compared with mean values around 2 in the PCA group (P<0.01). During the study period the patients in the PCA group received more ketobemidone as compared with the NCA group, 61.9±24.0 mg and 36.3±20.2 mg, respectively (P<0.01). Additional oral analgesics were used in 12 of the patients in the NCA group compared with none in the PCA group. The few side effects reported were equally distributed between the two groups.

    Conclusion: PCA treatment after coronary artery bypass surgery resulted in better pain treatment and the use of more opioid without an increase in side effects compared with traditional NCA treatment.

  • 3.
    Holmér Pettersson, Pia
    et al.
    Department of Cardiothoracic Surgery and Anaesthesiology Karolinska University Hospital Solna S-171 76 Stockholm.
    Jakobsson, Jan
    Öwall, Anders
    Plasma concentrations following repeated rectal or intravenous administration of paracetamol after heart surgery2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 6, p. 673-677Article in journal (Refereed)
    Abstract [en]

    Background:  Paracetamol is commonly used for post-operative pain management in combination with more potent analgesics. The best route of paracetamol administration after major surgery, when oral intake may not be optimal, is not known. Our primary purpose was to study plasma concentrations after the 1st and 4th dose of 1 g of paracetamol given either rectally or intravenously (i.v.) after major surgery.

    Methods:  In this prospective, randomized study, 48 patients undergoing heart surgery were randomized upon arrival to the intensive care unit (ICU) to receive paracetamol every 6th hour either as suppositories or intravenous injections. In half the patients (n= 24), blood samples for paracetamol concentration were obtained before and 20, 40 and 80 min after the first dose. In the other patients (n= 24), additional samples were taken prior to, and at 20, 40, 80 min and 4 and 6 h after, the 4th dose.

    Results:  Plasma paracetamol concentration peaked (95 ± 36 μmol/l) within 40 min after initial i.v. administration but did not increase within 80 min after the 1st suppository. Plasma concentration before the 4th dose was 74 ± 51 and 50 ± 27 in the rectal and i.v. groups, respectively. Paracetamol concentration peaked 20 min after the 4th dose for the i.v. patients (210 ± 84 μmol/l) and declined to 99 ± 27 μmol/l at 80 min as compared with the rectal patients 69 ± 44 to 77 ± 48 μmol/l.

    Conclusion:  Both time course and peak plasma concentrations of paracetamol given rectally differ from the one seen after intravenous administration. The clinical impact of these differences needs further investigation.

  • 4.
    Holmér Pettersson, Pia
    et al.
    Department of Cardiothoracic Surgery and Anesthesiology Karolinska University Hospital S-171 76 Stockholm.
    Öwall, Anders
    Jakobsson, Jan
    Early bioavailability of paracetamol after oral or intravenous administration2004In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, ISSN 0001-5172, Vol. 48, no 7, p. 867-870Article in journal (Refereed)
    Abstract [en]

    Background:  Paracetamol is a peripherally acting analgesic commonly used in multimodal post-operative pain management to reduce the need for more potent analgesics with their unwanted side-effects. The dose and optimal galenical form for achieving analgesic concentrations is not well defined. The primary aim of this pilot project was to study the early bioavailability for two fixed doses of orally administrated paracetamol and one dose of intravenous propacetamol, all of which were given after minor surgery.

    Methods:  Thirty-five patients undergoing day surgery were divided into five groups, seven patients each. Groups received either 1 g of an ordinary paracetamol tablet, 2 g of an ordinary paracetamol tablet, 1 g of a bicarbonate paracetamol tablet, 2 g of a bicarbonate paracetamol tablet or 2 g intravenously of prodrug propacetamol. We studied the plasma concentration of paracetamol during the first 80 min after administration.

    Results:  Within 40 min, intravenous propacetamol gave a median plasma paracetamol concentration of 85 µmol/l (range 65–161) and decreased thereafter. After oral administration, median plasma paracetamol concentration increased with increasing dose and time, but there were huge inter-individual differences at all time points studied. At 80 min after oral paracetamol the median plasma concentrations were 36 and 129 µmol/l for the 1- and 2-g groups, respectively, with an overall range between 0 and 306 µmol/l.

    Conclusion:  Oral administration of paracetamol as part of multimodal pain management immediately post-operatively resulted in a huge and unpredictable variation in plasma concentration compared with the intravenous administration.

  • 5.
    Nürnberg Damström, D.
    et al.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Saboonchi, Fredrik
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Sackey, P. V.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm,.
    Björling, Gunilla
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    A preliminary validation of the Swedish version of the critical-care pain observation tool in adults2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, ISSN 0001-5172, Vol. 55, no 4, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT.

    Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm- and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per- and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT.

    Results: The results provide indications of good agreement between the independent raters (ICC=0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (ρ=0.32–0.45).

    Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.

  • 6.
    Tegnestedt, Charlotta
    et al.
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Günther, A
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Reichard, A
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Bjurström, R
    Department of Environmental Medicine, Karolinska Institutet, Stockholm.
    Alvarsson, J
    Gösta Ekman laboratory, Department of Psychology, Stockholm University, Stockholm.
    Martling, CR
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Sackey, P
    Department of Anesthesiology, Surgical Sciences and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Levels and sources of sound in the intensive care unit: an observational study of three room types2013In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1041-1050Article in journal (Refereed)
    Abstract [en]

    Background

    Many intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds.

    Methods

    A-frequency S-time weighted equivalent continuous sound (LASeq), A-frequency S-time weighted maximum sound level (LASmax) and decibel C peak sound pressure (LCpeak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (> 5 min with LASmax < 55 dB and LCpeak < 75 dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds.

    Results

    Mean sound pressure levels (LASeq) ranged between 52 and 58 dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care.

    Conclusions

    Single-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.

1 - 6 of 6
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