Anders Aneman - Academia.edu (original) (raw)

Papers by Anders Aneman

Journal of the American College of Cardiology, 2015

BACKGROUND Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurol... more BACKGROUND Neuron-specific enolase (NSE) is a widely-used biomarker for prognostication of neurological outcome after cardiac arrest, but the relevance of recommended cutoff values has been questioned due to the lack of a standardized methodology and uncertainties over the influence of temperature management.

JAMA neurology, Jan 6, 2015

Brain injury affects neurologic function and quality of life in survivors after cardiac arrest. T... more Brain injury affects neurologic function and quality of life in survivors after cardiac arrest. To compare the effects of 2 target temperature regimens on long-term cognitive function and quality of life after cardiac arrest. In this multicenter, international, parallel group, assessor-masked randomized clinical trial performed from November 11, 2010, through January 10, 2013, we enrolled 950 unconscious adults with cardiac arrest of presumed cardiac cause from 36 intensive care units in Europe and Australia. Eleven patients were excluded from analysis for a total sample size of 939. Targeted temperature management at 33°C vs 36°C. Cognitive function was measured by the Mini-Mental State Examination (MMSE) and assessed by observers through the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Patients reported their activities in daily life and mental recovery through Two Simple Questions and their quality of life through the Medical Outcomes Study 36-Item Short ...

Intensive care medicine, 2014

We assessed long-term mortality and hospitalisation in patients with severe sepsis resuscitated w... more We assessed long-term mortality and hospitalisation in patients with severe sepsis resuscitated with hydroxyethyl starch (HES) or Ringer's acetate. This was an investigator-initiated, parallel-grouped, blinded randomised trial using computer-generated allocation sequence and centralised allocation data that included 804 patients with severe sepsis needing fluid resuscitation in 26 general intensive care units (ICUs) in Scandinavia. Patients were allocated to fluid resuscitation using either 6% HES 130/0.42 or Ringer's acetate during ICU admission. We assessed mortality rates at 6 months, 1 year and at the time of longest follow-up and days alive and out of hospital at 1 year. The vital status of all patients was obtained at a median of 22 (range 13-36) months after randomisation. Mortality rates in the HES versus Ringer's groups at 6 months were 53.3 (212/398 patients) versus 47.5% (190/400) [relative risk 1.12; 95% confidence interval (CI) 0.98-1.29; P = 0.10], respecti...

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2014

To investigate the potential of a computerised decision-support system (CDSS) to improve consiste... more To investigate the potential of a computerised decision-support system (CDSS) to improve consistency of haemodynamic evaluation and treatment suggestions by intensive care unit clinical staff with different levels of expertise and experience. Prospective observational study in a tertiary general ICU, of 20 patients admitted after elective cardiac surgery and assessed by staff specialists, senior registrars, registrars and nurses. A CDSS was used to display key cardiovascular variables, including mean systemic filling pressure analogue (Pmsa), heart efficiency (Eh) and vascular resistance (SVR). Staff were asked to score Pmsa, Eh and SVR ranging from -5 (grossly subnormal) through 0 (normal) to 5 (grossly supranormal), first without and then with access to the CDSS. Recommendations for therapeutic interventions were recorded. Maximal differences (diffmax) and the proportion of minimal disagreement (diffmin) between staff were evaluated. Without use of the CDSS, Pmsa was commonly unde...

Critical care medicine, 2000

To investigate the potential of specific angiotensin II subtype 1 (AT1) receptor blockade to modi... more To investigate the potential of specific angiotensin II subtype 1 (AT1) receptor blockade to modify the mesenteric hemodynamic response to acute hypovolemia and retransfusion. Prospective, randomized, controlled experimental study. University-affiliated animal research laboratory. Fasted, anesthetized, ventilated, juvenile domestic pigs of both sexes. Acute, graded hypovolemia by 20% and 40% of the total estimated blood volume followed by retransfusion in control animals (CTRL; n = 10) and animals pretreated with the AT1 receptor blocker candesartan (CAND; n = 10). Invasive monitoring of arterial and central venous blood pressures, cardiac output, portal venous blood flow, and jejunal mucosal blood flow. Blood gases were repeatedly analyzed to calculate oxygen delivery and consumption. Thirty minutes after each level of hypovolemia at 20% and 40%, cardiac output was decreased in CTRL animals from a baseline of 2.9 +/- 0.1 to 1.8 +/- 0.2 and 1.1 +/- 0.2 L/min, with no differences com...

Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critical... more Crit Care 1999, 3 3 ( (s su up pp pl l 1 1) ):P1 I In nt tr ro od du uc ct ti io on n: : Critically ill patients requiring intensive care are at risk of iatrogenic ocular damage. Studies have reported an incidence of eye problems of up to 40% in critically ill ventilated patients. We conducted this study to assess the incidence of ocular complications in our intensive care unit where all patients are cared for according to an eye care standard.

Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mi... more Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mills, M Mahfouf, DA Linkens P3 Comparison of closed with open tracheal aspiration system A Sanver, A Topeli, Y Çetinkaya, S Kocagöz, S Ünal P4 A laboratory assessment of the learning and retention of skills required to use the Combitube and Laryngeal Mask Airway by non-anaesthetists C Coles, C Elding, M Mercer P5 Pediatric airway exchange catheter can be a lifesaving device for the adult patients who have risk factors for difficult tracheal reintubation L Dosemeci, F Gurpinar, M Yilmaz, A Ramazanoglu P6 Cricothyroidotomy for elective airway management in critically ill trauma patients SM Wanek, EB Gagnon, C Rehm, RJ Mullins P7 Comparison of two percutaneous tracheostomy techniques I . Ö Akinci, P Ozcan, S Tug v rul, N Çakar, F Esen, L Telci, K Akpir P8 Percutaneous tracheostomy in patients with ARDS on HFOV S Shah, M Read, P Morgan P9 The dilatational tracheotomy -minimally-invasive, bed-side, inexpensive -but safe? MG Baacke, I Roth, M Rothmund, L Gotzen P10 Combination stenting for central airway stenosis P11 Ulcerative laryngitis in children admitted to intensive care M Hatherill, Z Waggie, L Reynolds, A Argent P12 Bronchial asthma in intensive care department: the factors influencing on exacerbation severity TA Pertseva, KE Bogatskaya, KU Gashynova P13 Severe BOOP M Mer, R Taylor, GA Richards P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study of its efficacy in an emergency department setting within the UK C Read, P16 Noninvasive positive pressure ventilation in patients with blunt chest trauma and acute respiratory failure S Milanov, M Milanov P17 Helium-oxygen (He-O 2 ) enhances oxygenation and increases carbon dioxide clearance in mechanically ventilated patients JAS Ball, R Cusack, A Rhodes, RM Grounds P18 Optimal method of flow and volume monitoring in patients mechanically ventilated with helium-oxygen (He-O 2 ) mixtures JAS Ball, A Rhodes, RM Grounds P19 Lessons learned from airway pressure release ventilation LJ Kaplan, H Bailey P20 Patient controlled pressure support ventilation D Chiumello, P Taccone, L Civardi, E Calvi, M Mondino, N Bottino, P Caironi P21 Impact of weaning failure in the evolution of patients under mechanical ventilation A Bruhn, P22 Abstract withdrawn P23 Rapid reduction of oxygenation index by employment of a recruitment technique in patients with severe ARDS GA Richards, H White, M Hopley P24 The effects of recruitment maneuver on oxygenation in primary and secondary adult respiratory distress syndrome S Tug v rul, N Çakar, IÖ Akinci, P Ergin Özcan, M Tug v rul, F Esen, L Telci, K Akpir Contents Available online http://ccforum.com/supplements/5/S1 Critical Care Vol 5 Suppl 1 Contents P25 Comparison of the P/V curve obtained by the supersyringe and the optoelectronic plethysmography D Chiumello, E Calvi, E Noe', L Civardi, E Carlesso, A Aliverti, R Dellacà P26 Assessment of static compliance and estimated lung recruitment as a tool for PEEP setting in ARDS patients P Dostal, V Cerny, R Parizkova P27 Positive end-expiratory pressure does not increase intraocular pressure in patients with intracranial pathology K Kokkinis, P Manolopoulou, J Katsimpris, S Gartaganis P28 Effects of lung recruitment and PEEP after CPB on pressure-absolute volume curves T Dyhr, A Larsson P29 The histopathological changes comparison in healthy rabbit lung ventilated with ZEEP, Sigh and PEEP Ç Yardimci, G Meyanci, H Öz, I Paksoy

Targeted temperature management was adopted as part of the treatment of unconscious survivors of ... more Targeted temperature management was adopted as part of the treatment of unconscious survivors of out-ofhospital cardiac arrest following the publication of two landmark studies which concluded that mild induced hypothermia (32°C to 34°C) improved survival and neurological outcome, substantiating the neuroprotective effect of mild hypothermia described in experimental animal data . Subsequently, this therapy was recommended by international guidelines and became a standard of care. Although both trials [1,2] had exclusion criteria limiting generalizability, mild induced hypothermia was applied to the wider cardiac arrest population.

Background: Specific angiotensin II (Ang II) receptors exist in many organs including peripheral ... more Background: Specific angiotensin II (Ang II) receptors exist in many organs including peripheral blood vessels, cardiac myocytes and the central nervous system. This suggests multiple sites of actions for Ang II throughout the cardiovascular system. Cardiac effects of Ang II are not completely understood, though its prominent vasoconstrictor actions are well described. This study was designed to assess left ventricular function during administration of Ang II using relatively load-independent methods in a whole-animal model. Methods: Ang II was infused in incremental doses (0-200 mg ¡ h ª1 ) in anaesthetised instrumented pigs (nΩ10). Cardiac systolic and diastolic function were evaluated by analysis of the left ventricular pressure-volume relationship. Results: Heart rate (HR), mean arterial pressure (MAP) and systemic vascular resistance (SVR) increased dose-dependently with Ang II, while cardiac output (CO) remained unchanged. Systolic function indices, end-systolic elastance (E es ) and pre-

To find out what effect insufflation pressure and type of gas have on intestinal perfusion during... more To find out what effect insufflation pressure and type of gas have on intestinal perfusion during pneumoperitoneum. Randomized, controlled, prospective, experimental study. University affiliated animal experimental laboratory, Sweden. Fasted, anaesthetised, domestic pigs of both sexes operated on laparoscopically (n = 7, weight 26-31 kg). Insufflation of carbon dioxide (CO2), nitric oxide (NO), or nitrogen (N2) at intra-abdominal pressures of 0, 5, 10, 15 and 20 mm Hg. Cardiac output, portal blood flow, and jejunal mucosal perfusion. Cardiac output decreased during N2 and NO (15, 20 mm Hg) but not during CO2 insufflation because of an accompanying tachycardia. Portal flow decreased during insufflation with N2 and NO (15, 20 mm Hg) and CO2 (20 mm Hg). Jejunal perfusion was reduced during N2 and NO insufflation (5-20 mm Hg) but remained unchanged during CO2 insufflation (5-20 mm Hg). Insufflation with CO2 maintained jejunal mucosal perfusion, probably as a result of hypercarbia as N2 at equal pressures reduced mesenteric flow. The vasodilator NO provided no haemodynamic benefit.

To examine the effects of hypertonic (7.5%) saline-6% dextran 70 (HSD) and isotonic (0.9%) saline... more To examine the effects of hypertonic (7.5%) saline-6% dextran 70 (HSD) and isotonic (0.9%) saline-6% dextran 70 (ISD) on cardiovascular function and intestinal perfusion in experimental endotoxin shock. Experimental, randomized, unblinded, interventional study. University experimental animal laboratory. Anesthetized and mechanically ventilated landrace pigs (n = 24). Induction of endotoxin (ET) shock by infusion of Escherichia coil lipopolysaccharide endotoxin (serotype 0111: B4) followed by no fluid treatment (control; C) or small-volume (4 mL/kg) treatment with HSD or ISD. Mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac output, portal vein blood flow, intestinal microcirculation, intramucosal (regional) P(CO2), intestinal-arterial gap of CO2, and intramucosal pH were monitored, and blood gases were analyzed. Infusion of ET resulted in hypokinetic shock, which in untreated animals led to cardiovascular deterioration and a survival rate of only 33% at 300 mins after start of ET infusion. ISD treatment transiently improved hemodynamic variables and mucosal blood flow but did not affect the survival rate vs. C. Significant beneficial, long-lasting effects of HSD infusion on hemodynamics, especially on mucosal blood flow and intramucosal pH, were demonstrable, resulting in a survival rate of 86%. The relative risk of death at 300 mins was 1.20 for ISD vs. C and 0.17 for HSD vs. C. Small-volume HSD resuscitation is much more effective than ISD resuscitation. Variables that were improved include cardiac output, portal blood flow, and intestinal mucosal blood flow in ET shock, all of which improve survival. Such beneficial effects of HSD on splanchnic perfusion may be of value in treating critically ill septic patients in the intensive care unit.

Current Opinion in Critical Care, 2013

To describe the theory behind arterial waveform analysis, the different variables that may be obt... more To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified. The precision of cardiac output (CO) measurements varies considerably and deteriorates during haemodynamic instability. Significant device-to-device differences exist. Nevertheless, most are sufficiently accurate for tracking changes in CO. Targeted intervention guided by haemodynamic monitoring reduces mortality and morbidity in high-risk surgical patients. Dynamic changes in variables such as systolic pulse variation, pulse pressure variation (PPV) and stroke volume variation (SVV) may be useful for evaluating fluid responsiveness, although important caveats exist. Newer indices such as PPV : SVV ratio may be useful in identifying preload and vasopressor-dependent patients. Peripheral arterial dP/dt has not been validated in critically ill patients and requires further investigation. Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.

Resuscitation, 2015

Please cite this article in press as: Winther-Jensen M, et al. Mortality and neurological outcome... more Please cite this article in press as: Winther-Jensen M, et al. Mortality and neurological outcome in the elderly after target temperature management for out-of-hospital cardiac arrest. Resuscitation (2015), http://dx.a b s t r a c t Aim: To assess older age as a prognostic factor in patients resuscitated from out-of-hospital-cardiac arrest (OHCA) and the interaction between age and level of target temperature management. Methods and results: 950 patients included in the target temperature management (TTM) trial were randomly allocated to TTM at 33 or 36 • C for 24 h. We assessed survival and cerebral outcome (cerebral performance category, CPC and modified Rankin scale, mRS) using age as predictor, dividing patients into 5 age groups: ≤65 (median), 66-70, 71-75, 76-80 and >80 years of age. Shockable rhythm decreased with higher age groups, p = 0.001, the same was true for ST segment elevation on ECG at admission, p < 0.01. Increasing age was associated with a higher mortality rate (HR = 1.04 per year, 95% CI = 1.03-1.06, p < 0.001) after adjusting for confounders. Octogenarians had an increased mortality (HR = 3.5, CI: 2.5-5.0, p < 0.001) compared to patients ≤65 years of age. Favorable vs. unfavorable outcome measured by CPC and mRS in survivors was different between age groups with adverse outcomes more prevalent in higher age groups (CPC: p = 0.04, mRS: p = 0.001). The interaction between age and target temperature allocation was not statistically significant for either mortality or neurological outcome. Conclusion: Increasing age is associated with significantly increased mortality after OHCA, but mortality rate is not influenced by level of target temperature. Risk of poor neurological outcome also increases with age, but is not modified by level of target temperature.

Critical Care Medicine, 2014

To determine the impact of introducing a two-tier system for responding to deteriorating ward pat... more To determine the impact of introducing a two-tier system for responding to deteriorating ward patients on ICU admissions after medical emergency team review. Retrospective database review before (2006-2009) and after (2011-2013) the introduction of a two-tier system. Tertiary, university-affiliated hospital. A total of 1,564 ICU admissions. Two-tier rapid response system. The median number of medical emergency team activations/1,000 hospitalizations increased from 22 to 31 (difference [95% CI], 9 [5-10]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) with a decreased rate of medical emergency team activations leading to ICU admission (from median 11 to 8; difference [95% CI], 3 [3-4]; p = 0.03). The median proportion of medical emergency team reviews leading to ICU admission increased for those triggered by tachypnoea (from 11% to 15%; difference [95% CI], 4 [3-5]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and by hypotension (from 27% to 43%; difference [95% CI], 15 [12-19]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and decreased for those triggered by reduced level of consciousness (from 20% to 17%; difference [95% CI], 3 [2-4]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) and by clinical concern (from 18% to 9%; difference [95% CI], 10 [9-13]; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The proportions of ICU admissions following medical emergency team review did not change significantly for tachycardia, seizure, or cardiorespiratory arrest. The overall ICU mortality for admissions following medical emergency team review for tachypnoea, tachycardia, and clinical concern decreased (from 29% to 9%: difference [95% CI], 20 [11-29]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) but did not change for the other triggers. The Acute Physiology and Chronic Health Evaluation predicted and observed ICU mortality and the proportion of patients dying with a not-for-resuscitation order decreased. The introduction of a two-tier response to clinical deterioration increased ICU admissions triggered by cardiorespiratory criteria, whereas admissions triggered by more subjective criteria decreased. The overall ICU mortality for patients admitted following medical emergency team review decreased, suggesting that the two-tier system led to earlier recognition of reversible pathology or a decision not to escalate the level of care.

Resuscitation, Jan 25, 2015

Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA... more Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia in comatose patient resuscitated from NSR. Hundred seventy-eight patients out of 950 in the TTM trial with an initial NSR were randomly assigned to targeted temperature management at either 33°C (TTM33, n=96) or 36°C (TTM36, n=82). We assessed mortality, neurologic function (Cerebral Performance Score (CPC) and modified Rankin Scale (mRS)), and organ dysfunction (Sequential Organ Failure Assessment (SOFA) score). Patients with NSR were older, had longer time to ROSC, less frequently had bystander CPR and had higher lactate levels at admission compared to patients with shockable rhythm, p<0.001 for all. Mortality in patients with NSR was 84% in both temperature groups (unadjusted HR 0.92, adjust...

Shock, 2000

Angiotensin II (AngII) is an important vasoconstrictor during hypovolemia. This study focused on ... more Angiotensin II (AngII) is an important vasoconstrictor during hypovolemia. This study focused on the effects of the AngII receptor blocker candesartan on intestinal, hepatic, and renal hemodynamics during severe hypovolemia when administered in preexisting moderate hypovolemia. It was hypothesized that specific AngII receptor blockade might enhance splanchnic perfusion during hypovolemia. Fasted, anesthetized, ventilated, juvenile pigs were hemorrhaged by 20% of the blood volume for 30 min. Animals were then randomized to receive candesartan (CAND, n = 11) or the vehicle (CTRL, n = 10) prior to further hemorrhage to 40% of the blood volume for 30 min. The shed blood was then retransfused. Systemic and splanchnic hemodynamics were recorded including intestinal mucosal, superficial and parenchymal hepatic, and cortical and medullary renal microcirculation by laser-Doppler flowmetry. Arterial blood gases were analysed. Candesartan-treated animals maintained mesenteric and jejunal mucosal perfusion during 40% hypovolemia compared to CTRL animals, while no differences were observed in the hepatic and renal circulation. Retransfusion restored mesenteric and renal blood flows despite persistent hypotension and reduced cardiac output in both CAND and CTRL animals. Renal medullary and hepatic parenchymal microcirculation failed to recover during retransfusion in both CAND and CTRL animals. Arterial acidosis, hypercarbia, and a negative base excess were observed in CTRL animals following retransfusion whereas those parameters were normalised in CAND animals. Administration of candesartan in moderate hypovolemia ameliorated the reduction and consequences of mesenteric and intestinal, but not hepatic perfusion during severe hypovolemia. No adverse effects were observed in the renal circulation.

New England Journal of Medicine, 2014

Blood transfusions are frequently given to patients with septic shock. However, the benefits and ... more Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established. In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay. The primary outcome measure was death by 90 days after randomization. We analyzed data from 998 of 1005 patients (99.3%) who underwent randomization. The two intervention groups had similar baseline characteristics. In the ICU, the lower-threshold group received a median of 1 unit of blood (interquartile range, 0 to 3) and the higher-threshold group received a median of 4 units (interquartile range, 2 to 7). At 90 days after randomization, 216 of 502 patients (43.0%) assigned to the lower-threshold group, as compared with 223 of 496 (45.0%) assigned to the higher-threshold group, had died (relative risk, 0.94; 95% confidence interval, 0.78 to 1.09; P=0.44). The results were similar in analyses adjusted for risk factors at baseline and in analyses of the per-protocol populations. The numbers of patients who had ischemic events, who had severe adverse reactions, and who required life support were similar in the two intervention groups. Among patients with septic shock, mortality at 90 days and rates of ischemic events and use of life support were similar among those assigned to blood transfusion at a higher hemoglobin threshold and those assigned to blood transfusion at a lower threshold; the latter group received fewer transfusions. (Funded by the Danish Strategic Research Council and others; TRISS ClinicalTrials.gov number, NCT01485315.).